Abstract
IntroductionAlthough there is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Previous research pointed to therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety as important factors in the underusage of exposure in the treatment of adult anxiety disorders. This study examined what therapist characteristics may be involved in the (non-)use of exposure in treating childhood anxiety disorders. MethodsAn internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety, depression and stress. ResultsThe current survey showed that therapists used exposure in about half of their cases of childhood anxiety and that the non-use was independently associated with the relatively strong negative beliefs about exposure, therapists’ age, and non-CBT orientation. DiscussionFindings point to the importance of addressing negative beliefs about exposure in therapists’ training and supervision to resolve therapy drift away from exposure, and consequently improve utilization and delivery of exposure-based therapy for childhood anxiety disorders.
Highlights
There is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice
There is consensus that exposure is key for the efficacy of interventions in treating childhood anxiety (Chorpita & Daleiden, 2009), several studies in the United States suggest exposure to be underused in clinical practice
It might seem good news that exposure is used in about half of the childhood anxiety cases, as this is much more than the 5% (Whiteside et al, 2016) or 15 % (Higa-McMillan et al, 2017) that was reported in the previously conducted surveys among youth mental health therapists in the USA
Summary
There is consensus that exposure is the key ingredient in treating childhood anxiety disorders, several studies in the USA suggest exposure to be underused in clinical practice. Methods: An internet-based survey among 207 youth mental health care professionals in the Netherlands and Belgium was conducted to assess therapists’ beliefs about exposure, their age, experience, caseload, training and theoretical orientation, as well as the level of the therapists’ own anxiety, depression and stress. Exposure-based cognitive behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders in youth (Chorpita et al, 2011), and is stated in international guidelines as first choice treatment (e.g., National Institute for Health and Care Excellence (2014). There is consensus that exposure is key for the efficacy of interventions in treating childhood anxiety (Chorpita & Daleiden, 2009), several studies in the United States suggest exposure to be underused in clinical practice. Therapists are found to use behavioural interventions like exposure infrequently in their care-asusual (McLeod & Weisz, 2010) and refrain from conducting exposure exercises, even in the context of a randomized controlled trial (RCT), where only 59 % of the youth received at least one session of exposure, with a mean number just under four sessions (Southam-Gerow et al, 2010)
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