The effects of an exposure therapy training program for pre-professionals in an intensive exposure-based summer camp

Sierra M Budd,Andrea D Guastello,Danielle L Cooke,Andrew G Guzick,Ryan J Mccarty,Ashley R Ordway,Lacie M Lazaroe,Carol A Mathews,Joseph P H Mcnamara,Seth T Downing

doi:10.1017/s1754470x22000010

Sierra M Budd, Andrea D Guastello + Show 8 more

Open Access

https://doi.org/10.1017/s1754470x22000010

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Abstract

Abstract Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed. Key learning aims (1) How can training of CBT techniques such as exposure occur prior to graduate education? (2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals? (3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?

Highlights

It has been posited that therapists’ proneness to feelings of disgust may play a role in the dissemination of exposure therapy (ET) when considering how frequently disgust is targeted in anxiety and obsessive-compulsive disorder (OCD), as exposures may be avoided by clinicians as to not elicit this aversive emotion (Reid, Bolshakova et al, 2017; Reid, Guzick et al, 2017)
The subsequent RM-multivariate analysis of variance (MANOVA) was conducted using the interaction between time and prior ET experience, and prior ET experience was included as a predictor for both sets of regressions predicting Conducting Exposures Scale (CCES) scores
In conclusion, a time-limited training experience that follows the principles of a live tieredsupervision model with modelling from more advanced clinicians and a hierarchical structure that provides incrementally more responsibility with increased competence is a promising method to enhance feelings of self-efficacy conducting ET, even amongst a group of preprofessionals with limited ET experience

Summary

Introduction

Exposure therapy (ET) is an effective treatment and a key element of cognitive behavioural therapy (CBT) for many anxiety disorders and obsessive-compulsive disorder (OCD; Abramowitz et al, 2019), a significant portion of mental health providers across the spectrum self-report that they either infrequently or never utilize ET in the treatment of anxiety for either youth (Higa-McMillan et al, 2017; Reid et al, 2018; Whiteside, Sattler et al, 2016) or adults (Becker et al, 2004; Freiheit et al, 2004; Hipol and Deacon, 2013; Pittig and Hoyer, 2017; van Minnen et al, 2010). Even among therapists who identify as cognitive behavioural therapists, use of ET is low compared with other cognitive behavioural techniques (Freiheit et al, 2004; Hipol and Deacon, 2013; Whiteside, Deacon et al, 2016) and when ET is utilized, clinicians report utilizing less effective forms of ET, such as imaginal exposures rather than in vivo exposures (Hipol and Deacon, 2013; Pittig and Hoyer, 2017; Sars and van Minnen, 2015; Reid et al, 2018) Given this concern, determining the barriers to the implementation of ET has become of empirical interest in recent years. Therapists may inadvertently model avoidance behaviour through not conducting exposures or approaching exposures in an overly cautious nature (Reid, Bolshakova et al, 2017; Waller and Turner, 2016)

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