استراتژی های آموزش مبتنی بر تئوری برای اصلاح نگرانی های پزشکان در مورد مواجهه درمانی

Despite the well-established efficacy of exposure therapy in the treatment of pathological anxiety, many therapists believe this treatment carries an unacceptably high risk for harm, is intolerable for patients, and poses a number of ethical quandaries. These beliefs have been shown to account for two related problems: (a) underutilization of exposure therapy, and (b) overly cautious and suboptimal delivery the treatment, which likely attenuates treatment outcomes. At present, there is little guidance for those who train exposure therapists to address these concerns. This article reviews therapist negative beliefs about exposure therapy and discusses their modification based on findings from social and cognitive psychology pertinent to belief change, including dual-processing in reasoning, the need for cognition and affect, and attitude inoculation. A number of strategies are offered for augmenting training in exposure therapy in order to promote positive beliefs about the treatment. These strategies involve: (a) therapists engaging in simulated exposure therapy exercises and presenting arguments in defense of exposure's safety, tolerability, and ethicality, and (b) training therapists using emotion-based appeals (e.g., case examples) to supplement research findings. Directions for future research on practitioner concerns about exposure therapy are discussed.

Exposure therapy is a central component of many cognitive-behavioral (CBT) approaches for anxiety disorders and entails guiding patients in repeatedly confronting feared stimuli. A wealth of randomized controlled trials demonstrate the effectiveness of exposure-based treatments for anxiety disorders such as panic disorder (e.g., Gloster et al., 2011) and obsessive–compulsive disorder (e.g., Foa et al., 2005), and meta-analyses support exposure-based therapy as an effective transdiagnostic approach for pathological anxiety (e.g., Norton & Price, 2007). The National Institute for Clinical Excellence (2011) and the American Psychiatric Association (2009) have published practice guidelines advocating exposure-based therapies as first-line treatment approaches for anxiety disorders. Despite its well-documented effectiveness in the treatment of pathological anxiety, exposure therapy is uniquely difficult to disseminate to practitioners owing to pervasive concerns about its use. Richard and Gloster (2007) noted that exposure suffers from a “public relations problem” among therapists, many of whom are concerned with the perceived intolerability and questionable ethicality of the treatment. More recently, Deacon, Farrell, et al. (2013-this issue) validated the Therapist Beliefs about Exposure Scale using a sample of over 600 practicing therapists. Mean scores on the scale indicated that the average clinician harbors a moderate degree of negative beliefs about exposure therapy. Surprisingly, negative beliefs about exposure are evident even among self-reported exposure therapists (Deacon et al., 2013a, Deacon et al., 2013c and Richard and Gloster, 2007). Clearly, in spite of its effectiveness, exposure therapy is viewed by many mental health professionals as a treatment that carries a number of unacceptable risks.