Australian and New Zealand psychologists’ perceptions and use of therapist-guided exposure for panic disorder

ABSTRACT

Cognitive behaviour therapy (CBT) has the strongest evidentiary support for the treatment of panic disorder. Specifically, interoceptive exposure (IE) has been found to be a critical component in the research literature. International studies have suggested that psychologists often avoid undertaking IE or do so in ways not consistent with evidence-based practice.

Objective

This study investigated whether this was true within an Australian and New Zealand context.

Method

A sample of 164 participants was included in an analysis of treatment modalities employed, exposure therapy implementation practices, use of other arousal reduction strategies and psychometric measures, negative beliefs regarding exposure therapy, general risk orientation, and self-reported actual treatment outcomes.

Results

Results revealed a wide variety of treatment models and implementation of exposure therapy techniques, influenced by widespread negative beliefs about exposure therapy which were significantly positively correlated with lower success rates in treatment outcomes.

Conclusions

The findings highlight the need for further research into the quality of current training methodologies, supervision practices, and ongoing professional development standards for exposure therapy techniques in the Australian and New Zealand contexts.

KEY POINTS

What is already known about this topic:

1. Interoceptive exposure (IE) is a critical component of cognitive behaviour therapy for panic disorder.

2. Research suggests that clinicians often do not use IE in their treatments or deliver IE in a way that differs substantially from the prolonged, intense IE supported by research.

3. In research with US therapists, negative beliefs about exposure were associated with suboptimal delivery of IE.

What this topic adds:

1. In a survey of Australian and New Zealand psychologists (N = 164) we investigated predictors of the evidence-based use of IE for the treatment of panic.

2. Increased negative beliefs about exposure therapy was related to less use of IE or modifying IE in ways not supported by research, and poorer treatment outcomes.

3. This article highlights implications for training and supervision practices and professional development standards.

KEYWORDS:

• Cognitive-behaviour therapy
• panic disorder
• interoceptive exposure
• therapist beliefs

Acknowledgments

The authors thank Dr. Brett Deacon for providing permission to use the TBES; the Australian Clinical Psychology Association (ACPA), Australian Psychological Society (APS), New Zealand Psychological Society (NZPsS), and New Zealand College of Clinical Psychologists (NZCCP); the participants; and Rhys Luckey, for statistical analyses guidance.

Disclosure statement

No potential conflict of interest was reported by the author(s).