Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-19T07:36:01.945Z Has data issue: false hasContentIssue false
  • English
  • Français

The German Adaptation of the Therapist Beliefs about Exposure Scale: a Validation Study among Licensed Cognitive Behavioural Therapists in Germany

Published online by Cambridge University Press:  13 June 2018

Sarah Schumacher Open the ORCID record for Sarah Schumacher [Opens in a new window] ,
Nadine M. Schopka ,
Manuel Heinrich  and
Christine Knaevelsrud
Sarah Schumacher*
Affiliation:
Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Nadine M. Schopka
Affiliation:
Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Manuel Heinrich
Affiliation:
Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Christine Knaevelsrud
Affiliation:
Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
*
*Correspondence to Sarah Schumacher, Freie Universität Berlin, Division of Clinical Psychological Intervention, Department of Education and Psychology, Habelschwerdter Allee 45, 14195 Berlin, Germany. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Exposure is an effective intervention in the treatment of pathological anxiety, but it is insufficiently disseminated. Therapists’ negative attitudes towards exposure might be of relevance when considering factors contributing to the non-application of this intervention. Aims: In order to be able to measure concerns in German-speaking therapist populations, the study aimed at validating a German version of the Therapist Beliefs about Exposure Scale.Method: The scale was translated into the German language and validated in a sample of 330 German licensed cognitive behavioural therapists. Results: In the present sample, the mean total score was significantly lower than in the original study including US-American therapists. Confirmatory factor analysis did not confirm the proposed one-factor model, while the exploratory factor analysis indicated that more than one factor is necessary to explain the structure of negative attitudes towards exposure. The internal consistency was high. Higher scores (more negative beliefs) were significantly correlated with older age, holding a master's degree (vs PhD), not being specialized in the treatment of anxiety disorders and with less experience with performance of exposure gained during clinical training. Negative beliefs about exposure were further associated with the self-reported average number of sessions spent on exposure in current treatment of post-traumatic stress disorder and panic disorder, and with negative attitudes towards application of exposure sessions presented in case vignettes. Conclusions: The German adaptation provides the opportunity of measuring concerns regarding application of exposure in German-speaking therapist populations. However, the presented data reveal suggestions for further scale development.

Keywords

exposurecognitive behavioural therapytherapistsanxiety disordersdissemination
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 2 , March 2019 , pp. 164 - 180
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2011). American Psychiatric Association Practice Guidelines. Retrieved from: http://www.psychiatryonline.com/guidelines.aspxGoogle Scholar
Bandelow, B., Lichte, T., Rudolf, S., Wiltink, J. and Beutel, M. (2015). S3-Leitlinie zur Behandlung von Angststörungen. Berlin, Heidelberg: Springer.Google Scholar
Beck, A. T., Emery, G. and Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.Google Scholar
Becker, C. B., Zayfert, C. and Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292. doi:10.1016/S0005-7967(03)00138-4Google Scholar
Böhm, K. and Külz, A. (2008). Versorgungsrealität der zwangsstörungen: werden expositionsverfahren eingesetzt? Verhaltenstherapie, 18, 18–24.Google Scholar
Bouton, M. E. (1993). Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychological Bulletin, 114, 80–99.Google Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi: 10.1037/0033-2909.112.1.155Google Scholar
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. and Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. doi:10.1016/j.brat.2014.04.006Google Scholar
Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R. and McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772–780. doi:10.1016/j.janxdis.2013.04.006Google Scholar
Eid, M. and Schmidt, K. (2014). Testtheorie und Testkonstruktion (vol. 1). Göttingen: Hogrefe.Google Scholar
Farrell, N. R., Deacon, B. J., Dixon, L. J. and Lickel, J. J. (2013a). Theory-based training strategies for modifying practitioner concerns about exposure therapy. Journal of Anxiety Disorders, 27, 781–787. doi: 10.1016/j.janxdis.2013.09.003Google Scholar
Farrell, N. R., Deacon, B. J., Kemp, J. J., Dixon, L. J. and Sy, J. T. (2013b). Do negative beliefs about exposure therapy cause its suboptimal delivery? An experimental investigation. Journal of Anxiety Disorders, 27, 763–771. doi: 10.1016/j.janxdis.2013.03.007Google Scholar
Flatten, G., Gast, U., Hofmann, A., Knaevelsrud, C., Lampe, A., Liebermann, P. et al. (2011). S3-LEITLINIE Posttraumatische Belastungsstörung ICD-10: F43. 1. Trauma und Gewalt, 5, 202–210.Google Scholar
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E. et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151–161. doi: 10.1176/appi.ajp.162.1.151Google Scholar
Freiheit, S. R., Vye, C., Swan, R. and Cady, M. (2004). Cognitive-behavioral therapy for anxiety: is dissemination working? The Behavior Therapist, 27, 25–32.Google Scholar
Gloster, A. T., Wittchen, H.-U., Einsle, F., Lang, T., Helbig-Lang, S., Fydrich, T. et al. (2011). Psychological treatment for panic disorder with agoraphobia: a randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT. Journal of Consulting and Clinical Psychology, 79, 406–420. doi: 10.1037/a0023584Google Scholar
Gunter, R. W. and Whittal, M. L. (2010). Dissemination of cognitive-behavioral treatments for anxiety disorders: overcoming barriers and improving patient access. Clinical Psychology Review, 30, 194–202. doi: 10.1016/j.cpr.2009.11.001Google Scholar
Harned, M. S., Dimeff, L. A., Woodcock, E. A. and Skutch, J. M. (2011). Overcoming barriers to disseminating exposure therapies for anxiety disorders: a pilot randomized controlled trial of training methods. Journal of Anxiety Disorders, 25, 155–163. doi: 10.1016/j.janxdis.2010.08.015Google Scholar
Hipol, L. J. and Deacon, B. J. (2013). Dissemination of evidence-based practices for anxiety disorders in Wyoming: a survey of practicing psychotherapists. Behavior Modification, 37, 170–188. doi: 10.1177/0145445512458794Google Scholar
Hohagen, F., Wahl-Kordon, A., Lotz-Rombaldi, W. and Muche-Borowski, C. (2015). S-3 Leiltlinie Zwangsstörungen (vol. 1). Berlin Heidelberg: Springer-VerlagGoogle Scholar
Hoyer, J., Beesdo, K., Gloster, A. T., Runge, J., Hofler, M. and Becker, E. S. (2009). Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychotherapy and Psychosomatics, 78, 106–115. doi: 10.1159/000201936Google Scholar
Kelava, A. and Moosbrugger, H. (2012). Deskriptivstatistische Evaluation von Items (Itemanalyse) und Testwertverteilungen. In Moosbrugger, H. and Kevala, A. (eds), Testtheorie und Fragebogenkonstruktion. Berlin, Heidelberg: Springer.Google Scholar
Lang, T., Helbig-Lang, S., Gloster, A. T., Richter, J., Hamm, A. O., Fehm, L. et al. (2012). Effects of therapist-guided exposure in CBT for panic disorder and agoraphobia. Zeitschrift Fur Klinische Psychologie Und Psychotherapie, 41, 114–124. doi: 10.1026/1616-3443/a000139Google Scholar
McLean, C. P. and Foa, E. B. (2013). Dissemination and implementation of prolonged exposure therapy for posttraumatic stress disorder. Journal of Anxiety Disorders, 27, 788–792. doi:10.1016/j.janxdis.2013.03.004Google Scholar
Mitte, K. (2005). A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders, 88, 27–45. doi: 10.1016/j.jad.2005.05.003Google Scholar
National Institute for Clinical Excellence (2011). Clinical Guidelines. NICE.Google Scholar
Olatunji, B. O., Deacon, B. J. and Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16. doi: 10.1016/j.cbpra.2008.07.003Google Scholar
Powers, M. B. and Deacon, B. J. (2013). Dissemination of empirically supported treatments for anxiety disorders: introduction to the special issue. Journal of Anxiety Disorders, 27, 743–744. doi: 10.1016/j.janxdis.2013.09.013Google Scholar
Roth, C., Siegl, J., Aufdermauer, N. and Reinecker, H. (2004). Therapie von Angst- und Zwangspatienten in der verhaltenstherapeutischen Praxis. Verhaltenstherapie, 14, 16–21.Google Scholar
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A. and Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574.Google Scholar
Sanchez-Meca, J., Rosa-Alcazar, A. I., Marin-Martinez, F. and Gomez-Conesa, A. (2010). Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical Psychology Review, 30, 37–50. doi: 10.1016/j.cpr.2009.08.011Google Scholar
Sars, D. and van Minnen, A. (2015). On the use of exposure therapy in the treatment of anxiety disorders: a survey among cognitive behavioural therapists in the Netherlands. BMC Psychology, 3, 1–10. doi: 10.1186/s40359-015-0083-2Google Scholar
Schermelleh-Engel, K., Mossbrugger, H. and Müller, H. (2003). Evaluating the fit of structural equation models: test of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8, 23–74.Google Scholar
Schulte, D., Künzel, R., Pepping, G. and Schulte-Bahrenberg, T. (1992). Tailor-made versus standardized therapy of phobic patients. Advances in Behaviour Research and Therapy, 14, 67–92. doi: https://doi.org/10.1016/0146-6402(92)90001-5Google Scholar
Schumacher, S., Gaudlitz, K., Plag, J., Miller, R., Kirschbaum, C., Fehm, L. et al. (2014). Who is stressed? A pilot study of salivary cortisol and alpha-amylase concentrations in agoraphobic patients and their novice therapists undergoing in vivo exposure. Psychoneuroendocrinology, 49, 280–289. doi: 10.1016/j.psyneuen.2014.07.016Google Scholar
Schumacher, S., Miller, R., Fehm, L., Kirschbaum, C., Fydrich, T. and Ströhle, A. (2015). Therapists’ and patients’ stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: a preliminary observational study. Psychiatry Research, 230, 668–675. doi: https://doi.org/10.1016/j.psychres.2015.10.020Google Scholar
Talepasand, S., Alijani, F. and Rezaie, A. (2010). Exploring factor structure of the dysfunctional attitudes scale. Procedia Social and Behavioral Sciences, 5, 1400–1408.Google Scholar
Wang, L. L., Watts, A. S., Anderson, R. A. and Little, T. D. (2013). Common fallacies in quantitative research methodology. The Oxford Handbook of Quantitative Methods (pp. 718–738). Oxford: Oxford University Press.Google Scholar
Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B. and Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: a meta-analysis. Clinical Psychology Review, 28, 1021–1037. doi: 10.1016/j.cpr.2008.02.007Google Scholar
Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford: Stanford University Press.Google Scholar
Supplementary material: File

Schumacher et al. supplementary material

Appendices A-B

Download Schumacher et al. supplementary material(File)
File 33.1 KB
Submit a response

Comments

No Comments have been published for this article.