Pub Discussion Melbourne - Assoc Professor Brett Deacon: exposure therapy

The diagnosis and treatment of exposaphobia, or why clinicians dislike exposure therapy and what to do about it

Associate Professor Brett Deacon

University of Melbourne

Exposure therapy for anxiety is as effective as it is challenging.

Concerns about safety, tolerability, and ethicality are common and may cause therapists to deliver exposure suboptimally or not at all. In this presentation, negative beliefs about exposure are normalised and discussed in light of relevant scientific evidence. Strategies for overcoming them in routine clinical practice are reviewed and practiced.

Exposure-based CBT (exposure therapy) is the most effective treatment for anxiety-related disorders. However, clinicians often forego the use of exposure in favour of more “feel good” but less effective techniques such as cognitive restructuring, relaxation, controlled breathing, and mindfulness. Even when therapists use exposure, it is often delivered in an unnecessarily cautious manner that compromises its benefits. Our profession’s failure to disseminate exposure therapy to anxious clients is recognised worldwide as a significant public health problem. A concerted international effort is underway to improve this situation.

At the heart of this effort is an understanding of the reasons why clinicians often do not use exposure therapy and do so suboptimally. In addition to issues like lack of training and organisational support, concerns that exposure is unsafe, intolerable, and unethical have emerged as a critical barrier to the effective use of exposure. These concerns directly translate into the way clinicians deliver exposure. For example, research shows therapists concerned about exposure select easier exposure hierarchies and exposure tasks, engage in more anxiety-reducing as opposed to anxiety-increasing behaviours during exposures, and use a host of safety behaviours due to concerns that they are necessary to protect the client, reduce risk, and manage their own anxiety. These concerns about harm and associated safety behaviours may be formulated much the same way we understand maladaptive threat beliefs and avoidance behaviours in anxious clients. And the solution is the same: exposure, or more accurately, “exposure to exposure”.

In this presentation, I discuss research on therapist reservations about exposure, the various ways these can impair the effective delivery of exposure, and specific strategies for acquiring more confidence in the safety, tolerability, and ethicality of exposure therapy in one’s own clinical practice using the “exposure to exposure” principle as a guide.

About this event:

The format will be a 1-hour, lecture-style presentation, in an informal setting, including an opportunity for open Q&A – bring your questions!

Please note that this event will take place on level 1 of the venue and is accessible via stairs only.

Key Learning Objectives

1. Understand common negative beliefs about exposure therapy for anxiety, including one’s own.
2. Understand how these beliefs affect the delivery of therapy in ways that may compromise client care.
3. Learn strategies for challenging concerns about exposure therapy while delivering exposure in a more confident, intensive, and effective manner.

This session is suitable for all levels of clinician / therapist.

Duration & Format / Training Modalities

This event will be approx. 60 minutes for CPD and Q&A. This event does not include any catering in the ticket price.

Doors open at 6:00pm for a 6:30pm start.

Please note that this event will take place on level 1 of the venue and is accessible via stairs only.

References – readings

1. Deacon, B. J., Farrell, N., Kemp, J., Dixon, L., Sy, J., Zhang, A., & McGrath, P. (2013). Assessing therapist reservations about exposure therapy for anxiety: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772-780.
2. Farrell, N. R., Kemp, J. J., Blakey, S. M., Meyer, J. M., & Deacon, B. J. (2016). Targeting clinician concerns about exposure therapy: A pilot study comparing standard vs. enhanced training. Behaviour Research and Therapy, 85, 53-59.
3. Meyer, J. M., Kelly, Peter J., & Deacon, B. J. (2020). Therapist beliefs about exposure therapy implementation. The Cognitive Behaviour Therapist, 13, 1-14.

Dr. Brett Deacon has been studying, teaching, supervising, and practicing exposure therapy for anxiety for over 25 years. He is co-author of Exposure Therapy for Anxiety: Principles and Practice (2nd ed.), published in 2019 by Guilford Press. Brett has maintained a private practice in Australia for 10 years (5 years full-time) and specialises in exposure-based CBT for anxiety issues, most notably OCD, panic, and social anxiety disorder. His research focuses on the nature, correlates, and consequences of negative beliefs about exposure therapy. His Therapist Beliefs about Exposure Scale (TBES) has been translated into 5 languages and is used by research teams around the world to assist in training and evaluating clinicians. Brett’s work has identified (a) barriers to the effective use of exposure therapy such as concerns about its safety, tolerability, and ethicality and the perception that anxious clients are fragile, and (b) the effects of these barriers on how practitioners deliver exposure. Research by Brett and others has shown the benefit of strategies for challenging negative beliefs about exposure to promote its confident, effective, and ethical delivery.