Fear of Fear: Challenges and Negative Beliefs About Gradual Exposure Use in TF-CBT.

BACKGROUND: Gradual exposure (GE) is a key component of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Initial evidence suggests that negative beliefs about GE may partially explain suboptimal exposure implementation. OBJECTIVE: The current study sought to evaluate GE negative beliefs and determine what professional factors might contribute to them. METHODS: Participants (N = 742; 85.71% cisgender women; 67.25% White; M age(SD)=36.06[10.47]) who recently engaged in TFCBTWeb2.0 filled-out questionnaires assessing their views of GE within TF-CBT, evidence-based practice (EBP), TF-CBT implementation, and training experiences. Beliefs about GE and difficulty implementing TF-CBT were compared across various professional characteristics (e.g. TF-CBT experience, student status). Structural equation modeling (SEM) was utilized to evaluate which professional characteristics may relate to negative beliefs about TF-CBT GE. RESULTS: The most negatively rated TF-CBT GE beliefs included concerns about youth experiencing negative effects from exposure, endangering confidentiality, and provider vicarious trauma. Participants who used TF-CBT with a patient generally had less negative GE beliefs compared to those who had never used TF-CBT. In the SEM analysis, general TF-CBT negative beliefs and beliefs about EBP were significant predictors, such that participants who reported more general negative beliefs about TF-CBT and EBP were more likely to report stronger negative GE beliefs. CONCLUSIONS: These results suggest that negative beliefs about GE can be a target during training to improve TF-CBT implementation, and that novel training approaches (e.g. experiential training) that specifically address negative GE beliefs are needed given the lack of currently available trainings in this domain.