Predicting adoption of exposure therapy in a randomized controlled dissemination trial

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.

► We examine predictors of adoption of exposure therapy (ET) 12 weeks after training.
► Therapist academic degree, self-efficacy, and knowledge predict use of ET.
► Organizational barriers and having anxious clients predict proficiency in ET.
► Therapist anxiety sensitivity, attitudes, and knowledge predict proficiency in ET.
► Several predictor effects varied depending on the type of training received.