The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study.

Abstract

Exposure therapy is a central part of cognitive behavior therapy (CBT) for eating disorders, but is underused in routine clinical practice, at least partly because clinicians often hold very negative views about this technique. Although uncontrolled cohort studies suggest that teaching clinicians to use exposure improves their attitudes, there is a need for more robust empirical designs. This study uses a nonrandomized controlled design to test whether teaching on exposure improves clinicians' attitudes to its use, and whether clinician characteristics influence such change. Forty-seven clinicians undertook 90 min of teaching on exposure therapy within CBT, while 42 other clinicians undertook 90 min of teaching on CBT for eating disorders. Each completed the Therapist Beliefs about Exposure Scale at the outset and end of the intervention, and the Intolerance of Uncertainty Scale at the outset. Both groups showed improved attitudes to exposure therapy following the teaching, but the change was substantially larger in the Exposure teaching group (d = 0.85) than in the Comparison group (d = .30). Preteaching characteristics did not have any substantial influence on this change in attitudes to exposure. These findings strengthen the conclusion that a simple teaching intervention can improve clinician attitudes to the exposure therapy element of CBT (and other therapies). However, the nonrandomized design and self-selected sample limit the interpretability of the findings. Further research is suggested to develop these findings and determine their link to clinician behavior in therapy.