How Can Therapists Overcome Their Own Negative Beliefs about Exposure Therapy?

By Gillian Wilson, MA, and Martin M. Antony, PhD, ABPP

Exposure therapy is a highly effective psychological treatment for a wide range of anxiety and related disorders. However, exposure therapy tends to be delivered less often than other evidence-based treatments, and when exposure is used, it is not always implemented with an appropriate level of competency.  

An important contributing factor to the underutilization of exposure therapy and its substandard implementation is therapists’ own negative beliefs or misconceptions about exposure. Below are some common misconceptions and suggestions for how to overcome them:

1. Misconception: Exposure therapy causes clients undue distress and has adverse consequences.

Suggestions: Although exposure therapy can lead to temporary increases in anxiety symptoms, it is important to remember that these symptoms are not dangerous, and that exposure is generally carried out in a very gradual and predictable way. Further, exposure very rarely causes clients harm, and it is imperative that therapists know their clients’ medical histories. For example, a client with a respiratory condition would not be asked to complete an exposure designed to elicit hyperventilation.  

2. Misconception: Exposure therapy undermines the therapeutic relationship and leads to high dropout.

Suggestions: If therapists provide their clients with a clear rationale for exposure and deliver optimal treatment, the client is more likely to experience positive outcomes (e.g., symptom reduction), which in turn can strengthen the therapeutic relationship. Additionally, there is evidence that dropout rates for exposure are comparable to other treatments.

3. Misconception: Exposure therapy can lead to malpractice lawsuits against therapists.

Suggestions: Survey data suggest that malpractice lawsuits against therapists in regards to exposure are extremely rare. Nonetheless, as with any form of therapy, there are a number of steps that therapists can take to protect themselves from a legal standpoint, including obtaining informed consent from clients throughout treatment and ensuring that treatment is delivered with the highest level of competency, professionalism, and ethical consideration.

Gillian Wilson is a doctoral student in psychology at Ryerson University in Toronto, ON, Canada.

Martin M. Antony is a professor of psychology at Ryerson University, and author of thirty books, including The Shyness and Social Anxiety Workbook.