title: Predicting adoption of exposure therapy in a randomized controlled dissemination trial.
abstract: The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence of facilitating factors. Overall, these results suggest that the primary barriers to the adoption of ET are therapist, not organizational or client, factors.
authors.affiliation: Behavioral Tech Research, Inc., Seattle, WA, United States. Electronic address: mharned@btechresearch.com.
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Harned
authors.forename: Linda A
authors.initials: LA
authors.lastname: Dimeff
authors.forename: Eric A
authors.initials: EA
authors.lastname: Woodcock
authors.forename: Ignacio
authors.initials: I
authors.lastname: Contreras
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007171:Implosive Therapy / Q000193:education* / Q000379:methods; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015279:Organizational Culture; D010361:Patients; D020377:Self Efficacy
keywords: Anxiety disorders; Dissemination; Exposure therapy; Implementation; Online training
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):1050-62
references.pmid: 15612851
references.citation: Behav Ther. 2014 Nov;45(6):731-44
references.pmid: 25311284
references.citation: Med Educ. 2002 May;36(5):412-7
references.pmid: 12028390
references.citation: Community Ment Health J. 2008 Aug;44(4):227-44
references.pmid: 18157693
references.citation: J Clin Psychol. 2012 Jan;68(1):8-23
references.pmid: 21901749
references.citation: J Trauma Stress. 2004 Jun;17(3):213-22
references.pmid: 15253093
references.citation: Behav Res Ther. 2004 Mar;42(3):277-92
references.pmid: 14975770
references.citation: Br J Cancer. 1978 May;37(5):849-57
references.pmid: 350254
references.citation: J Subst Abuse Treat. 2009 Sep;37(2):191-202
references.pmid: 19339139
references.citation: J Nerv Ment Dis. 2007 Jun;195(6):521-31
references.pmid: 17568301
references.citation: Behav Res Ther. 2009 Nov;47(11):921-30
references.pmid: 19695562
references.citation: Ment Health Serv Res. 2004 Jun;6(2):61-74
references.pmid: 15224451
references.citation: Psychiatr Serv. 2001 Jul;52(7):935-42
references.pmid: 11433111
references.citation: Adm Policy Ment Health. 2007 Jul;34(4):319-30
references.pmid: 17268858
references.citation: Behav Res Ther. 2010 Apr;48(4):312-20
references.pmid: 20056195
references.citation: Am J Psychiatry. 1999 Nov;156(11):1819-21
references.pmid: 10553751
references.citation: Psychiatr Serv. 2009 Jun;60(6):823-30
references.pmid: 19487354
references.citation: Clin Psychol (New York). 2010 Mar;17(1):1-30
references.pmid: 20877441
references.citation: Child Maltreat. 2012 Feb;17(1):86-95
references.pmid: 22089827
references.citation: J Anxiety Disord. 2011 Mar;25(2):155-63
references.pmid: 20888186
references.citation: Int J Nurs Stud. 2007 Mar;44(3):397-405
references.pmid: 16631177
references.citation: Behav Res Ther. 1986;24(1):1-8
references.pmid: 3947307