Why do clinicians exclude anxious clients from exposure therapy?

• Published in: Behaviour research and therapy Vol. 54; pp. 49 - 53
• Main Authors: Meyer, Johanna M., Farrell, Nicholas R., Kemp, Joshua J., Blakey, Shannon M., Deacon, Brett J.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-03-2014; Elsevier; Elsevier Science Ltd
• Subjects: Anxiety; Anxiety disorders; Anxiety Disorders - therapy; Attitude of Health Personnel; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical training; Cognitive-behavioral therapy; Dissemination; Emotions; Exceptions; Exposure therapy; Female; Health Knowledge, Attitudes, Practice; Humans; Implosive Therapy; Male; Medical sciences; Mental health care; Middle Aged; Patient Selection; Practice Patterns, Physicians; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychometrics; Psychopathology. Psychiatry; Quantitative psychology; Sensitivity; Therapists; Treatments; Cognitive-behavioral therapy; Anxiety disorders; Dissemination; Exposure therapy; Human; Affect affectivity; Cognitive therapy; Customer; Health staff; Anxiety disorder; Exposure; Treatment; Anxiety; Behavior therapy
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2014.01.004

Despite research demonstrating the effectiveness of exposure therapy for pathological anxiety, this treatment is underutilized by clinicians. Anecdotal evidence and clinical experience suggest that therapists who possess reservations about exposure therapy tend to exclude clients from this treatment based on client characteristics believed to predict worse response. When exceptions are made based on characteristics that do not reliably predict poor outcomes, clients face the opportunity cost associated with investment in less effective treatments. The present investigation assessed therapists' likelihood of excluding clients from exposure due to different client and therapist characteristics. Exposure therapists (N = 182) completed an online survey that included the Therapist Beliefs about Exposure Scale, Anxiety Sensitivity Index-3, and the Broken Leg Exception Scale (BLES), a novel measure assessing the likelihood of excluding clients from exposure based on 25 different client characteristics. The BLES demonstrated good psychometric properties. Client characteristics most likely to result in exclusion from exposure therapy were comorbid psychosis, emotional fragility, and reluctance to participate in exposure. Greater likelihood of excluding clients from exposure was associated with higher therapist anxiety sensitivity and endorsement of negative beliefs about exposure therapy. Clinical and training implications of these findings are discussed.
•We examined therapists' tendency to exclude patients from exposure therapy.•Common reasons for exclusion from exposure therapy were not empirically supported.•Therapists with higher anxiety sensitivity more often excluded clients.•Therapists with more negative beliefs about exposure more often excluded clients.•Exclusion of clients from exposure therapy reflects therapists' anxious concerns.