Motivating Clinicians to Learn and Use Exposure Therapy

Motivating Clinicians to Learn and Use Exposure Therapy

Although exposure-based treatments have been around for several decades, and exposure is arguably at the core of the most effective treatments for anxiety-related disorders, only a minority of clinicians actually use exposure in an intentional and planful way. Barriers include lack of knowledge, as well as concerns about potential harm, and a perceived rigidity in using exposure. One promising avenue for overcoming some of these barriers is easily accessible Internet-based training. A group of researchers associated with Behavioral Tech, the umbrella organization at the heart of the dissemination of Dialectical Behavior Therapy (DBT), conducted a study aimed at encouraging clinicians to use exposure-based treatments and training them in its use (i.e., Harned, Dimeff, Woodcock, & Skutch, 2011).


The Three Conditions Used in the Study

The researchers created an online multimedia training in exposure therapy. A total of 51 participants were randomly assigned to one of three conditions:

  1. An online training in exposure therapy (ET OLT), 
  2. Online training in exposure therapy plus 1-2 phone calls from the experimenters. In these brief calls, the experimenters responded to questions and attempted to increase engagement through using Motivational Interviewing. Motivational interviewing is a well-supported approach, but I should note that, as the authors admit, it’s impossible to know whether motivational interviewing had a unique effect, or whether the participants simply found it helpful to talk to the experimenters. 
  3. In an attempt to have a placebo condition (control OLT), a third of the participants didn’t receive exposure training at all. Instead, they received an online instruction in using DBT to validate clients

What Did They Find?

As it turns out, online training appears to be a viable means of educating therapists about exposure therapy and increasing therapist confidence in using exposure. The addition of the phone calls appeared to improve attitudes towards exposure therapy beyond the training alone, but it’s hard to know for certain whether this is because the phone calls were rooted in motivational interviewing or simply because the therapists had a chance to talk through their concerns with a knowledgeable and sympathetic person.

Limitations and What We Can Take Away

I’ll mention here that participants were recruited from a DBT listserv. That participants were on a DBT listserv suggests that the pool of people were more favorably disposed towards evidence-based therapy than, for example, a Jungian listserv. That these individuals also volunteered for a research study further narrows the sample into people open to learn these sorts of treatments. Consequently, this isn’t a completely random sample of therapists.
One take home message from this study: access to decent training is major barrier to using exposure, and this barrier can be surmounted through online training. I think this is a pretty important point. There are therapists who want more training in exposure therapy, and the Internet is a very viable way of making training available.
Additionally, a brief (< 20 minutes) phone call or two can help grease the wheels and increase likelihood that someone will use the treatment.
The researchers looked at a number of other variables, but at the risk of cluttering this post, I’ll leave those out. If you’re interested, you can download a pdf of the article through NIH by clicking on the link below.


Harnad, M.S., Dimeff, L.A., Woodcock, E.A., & Skutch, J.M. (2011). Overcoming barriers to disseminating exposure therapies for anxiety disorders: A pilot randomized controlled trial of training methods. Journal of Anxiety Disorders, 25, 155-163.