The use of exposure in anxiety-related disorders and associations with practitioner characteristics

Despite their well-established efficacy in anxiety treatment, exposure-based interventions are underutilized. Surveying 190 practitioners (122 completed), the current study examined the use of exposure in various anxiety-related disorders and associations with practitioner-related characteristics. Results indicate that across anxiety-related disorders, exposure was used in 65.73% of the patients and on average 41.30% of treatment time is spent on exposure. More training and a CBT orientation are associated with higher utilization, perceived competence, and effectiveness. Practitioners used exposure less often in the treatment of posttraumatic stress disorder and generalized anxiety disorder compared to the other disorders. They perceive exposure as less effective for these disorders and perceive themselves as less competent to deliver exposure in these disorders. Negative beliefs about exposure and higher distress about using exposure were associated with lower utilization. Practitioners high on anxiety sensitivity and experiential avoidance reported more distress about using exposure. Considerable variability was reported in how practitioners deliver exposure, suggesting an eclectic approach rather than adhering to a specific theoretical framework. Investigating factors associated with exposure use can provide valuable insights into how to remediate. Our results suggest that promising targets to boost the use of exposure are training, as well as tackling negative beliefs and therapist distress.