Anxiety disorders are common among adults and youth and, when left untreated, are associated with several long-term negative sequelae. Anxiety disorders have a significant societal burden, with detrimental functional outcomes [1], loss of workforce productivity [2], and high health care costs [3]. Although cognitive behavioral therapy (CBT) has been deemed to be an efficacious treatment for anxiety disorders [4, 5], few patients in community settings receive CBT for anxiety. This gap is in part due to community therapists not having received adequate training in evidence-based practices (EBPs) [6]. In addition, therapists often report negative beliefs about exposure-based treatments, even though exposures are considered to be an active ingredient in effective treatment for anxiety disorders [7]. This gap between research evidence and ?real-world? community practice is the focus of implementation science (IS) research, which aims to increase the integration of research and practice. According to the systems-contextual framework of IS research [8], quality of training and an environment that supports behavior change are key variables for successful implementation. Although the ?gold standard? approach for training community therapists (i.e., workshop, manual, ongoing clinical supervision) has been shown to improve therapists' knowledge about EBPs [9], it has not lead to proficiency or adoption of the treatment. Strategies that might help to improve the adoption of empirically supported treatments in community settings include provision of support through consultation calls [10], as well as incorporating active learning [11] and experiential learning [e.g., 12, 13] strategies into therapist training. [This pilot study will assess the feasibility and acceptability of using an experiential workshop to train community therapists in exposure therapy by randomizing therapists to one of two training approaches.] Both training approaches will incorporate consultation calls and active learning strategies, but one training approach will also incorporate experiential learning. The experiential component of the workshop will have therapists themselves undergo a one-day treatment for fear of spiders ? a training approach that has not yet been examined empirically. [This study will use mixed methods (i.e., quantitative and qualitative measures) to examine the feasibility and acceptability of conducting a randomized trial examining the novel experiential training approach. Feasibility will be assessed via rates of recruitment and retention, assessment completion, and consultation call attendance. Acceptability will be assessed with a training satisfaction scale and qualitative interviews with a subset of participants. Mixed methods will how examine therapist-level correlates of exposure use are associated with therapist perceptions of feasibility and acceptability.] Consistent with the NIMH Strategic Objectives (4.2), this dissemination and implementation study will broaden the public health impact of research by informing best practices for training community therapists in exposure-based treatments.

Public Health Relevance

Anxiety disorders are a serious public health concern with high prevalence and societal burden. Although exposure-based cognitive behavioral therapy (CBT) is an efficacious treatment for anxiety, community mental health therapists report limited training in and negative attitudes toward exposure-based treatments. The proposed [pilot study will assess the feasibility and acceptability] of a novel experiential training program that aims to improve therapist attitudes toward and increase the adoption of exposure-based CBT.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1)
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Hill, Lauren D
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Temple University
Schools of Arts and Sciences
United States
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