Assessing the Link between Individual Differences in Distress Tolerance and the use of Exposure-Based Therapies in UK based Cognitive Behavioural Therapists

Despite the demonstrated effectiveness of exposure-based therapies, studies show that therapists often avoid using exposure or do so in ways not consistent with evidence-based practice. Delivering exposure in an overly cautious, suboptimal manner, such as in combination with arousal reduction techniques, has been shown to reduce exposures effectiveness and can exacerbate clients’ symptoms. Research points to therapist characteristics, such as experiential avoidance of discomfort, as interfering with exposure use and delivery. The present study used an online survey including a therapy case vignette to evaluate the extent to which CBT therapists practicing in the UK would choose to use exposure, and to explore the links between therapists’ traits related to their ability to tolerate distress, and their use and delivery of exposure. As part of this exploration, the role of ACT training on experiential avoidance, cognitive fusion, exposure use and exposure delivery was considered. Results show most therapists chose to use exposure therapy; however, they delivered exposure in a suboptimal manner. Therapists’ traits related to distress tolerance were significantly correlated with their use and delivery of exposure. Suggesting therapists who struggle to manage their own distress, are less likely to use exposure therapy and, if used, are more likely to deliver exposure in an overly cautious, suboptimal manner. We found participants trained in ACT, in addition to CBT, used exposure more and delivered it closer to recommended guidelines. Experiential avoidance and cognitive fusion fully mediated this relationship, suggesting ACT training improves therapists use and delivery of exposure through decreasing their experiential avoidance and cognitive fusion. The findings highlight the need for further research into therapist factors impacting exposure use, particularly into the role of empathy and when it leads to distress. This research suggests training and supervision aimed at decreasing therapists’ experiential avoidance and cognitive fusion, may improve both delivery and frequency of exposure use, alongside making organisational changes to reduce therapists distress linked to burnout.