On the use of exposure therapy in the treatment of anxiety disorders: a survey among cognitive behavioural therapists in the Netherlands

David Sars, Agnes van Minnen

Although research has shown exposure therapy to have earned its rank among empirically supported treatments (ESTs) for anxiety disorders, several US-based studies suggest it to be underused in clinical practice. Data on exposure use in Europe is mainly lacking, whereas its state of dissemination in countries such as the Netherlands has remained uncharted. Therefore, this study examined the use of exposure therapy among members of the Dutch Association for Behavioural and Cognitive Therapy (VGCt), as well as explored therapist, educational and contextual variables that could facilitate its dissemination in clinical practice. Respondents (n = 490) were surveyed on clinical interventions used in their treatment for social anxiety disorder, phobia, OCD and panic disorder. Data was collected on the use of (disorder) specific interventions, therapists' attitudes on exposure, treatment experience, current educational status, educational background and workplace characteristics. Analysis of the data showed that most therapists implemented exposure frequently, but that exposure use still warrants improvement, specifically for certain (disorder-specific) interventions that were accordingly underused. Confirming our hypothesis, we found that clinicians who practiced exposure regularly also reported a greater willingness to use the treatment, perceived the method as more credible, and saw fewer barriers for its usage than those who did so less. The use of (disorder-) specific interventions, such as in vivo exposure (therapist as well as self-directed), exposure and response prevention for OCD, and interoceptive exposure for panic disorder, was positively related to level of education. While most were satisfied with the training they had received, therapists did report a need for additional instruction in targeted practical, empirical, and diagnostic skills. Our findings support the conclusion that the dissemination of exposure therapy in the Netherlands progresses well, but that education in certain (disorder-specific) techniques merits augmentation. To bridge the gap between research and clinical practice, future research should therefore focus on new, preferably blended approaches to training clinicians in exposure techniques.