(PS3-D88) Community Clinicians' Use of Imaginal Exposure

Despite the efficacy of exposure therapy for the treatment of anxiety disorders, clinicians infrequently implement this treatment. When clinicians elect to implement exposure therapy, they are more likely to employ imaginal exposures rather than other forms of exposures (i.e., in-vivo and interoceptive). Such findings may be promising as they could reflect an underestimation of community exposure use, or these findings could reflect a diluted form of exposure that is unlikely to be helpful. We discuss the uses of imaginal exposure, investigate self-reported use of imaginal exposure in a community sample, and discuss implications and suggestions for clinicians. The current study uses community therapists’ (N = 178) survey responses to better understand the manner in which they use imaginal exposure to address childhood anxiety disorders. The therapists all worked with anxiety in child populations, but the sample varied in terms of education (doctoral level psychologists, social workers, counselors), years of clinical experience (ranged from 1 to 40 years with an average of 15 years), and orientation (CBT, psychodynamic, family systems, humanistic, eclectic). We hypothesized that therapists’ descriptions would be more consistent with use of imaginal exposures as a replacement for in vivo exposure, rather than to directly confront intrusive anxious thoughts. We also hypothesized that imaginal exposures would be less frequent than strategies that avoid (thought stopping) or cope with (cognitive restructuring) anxiety provoking thoughts, in general and during exposures. As expected, a RMANOVA indicated that the frequency with which therapists used the three forms of in-session exposure differed significantly, F(2, 348) = 200.03, p < .001, with planned contracts indicating that imaginal exposures (3.76, SD = 0.65), were used more than in vivo exposure, (3.01, SD = 1.16, p</em> < .001) and interoceptive (1.98, SD = 1.09, p</em> < .001). Correlations revealed that more frequent use of cognitive restructuring, thought stopping, and distraction was associated with more negative beliefs about exposure, higher perceptions as anxious youth as fragile, as well as beliefs that the therapist’s role is to decrease anxiety during exposure. Use of thought stopping and distraction were also negatively correlated with the belief that youth benefited from exposure through habituation. In contrast, use of repeating upsetting thoughts was associated with more positive beliefs about exposure, lower perception of anxious youth as fragile, endorsement of a habituation view of exposures, and the view that the therapist’s role is to increase (and not decrease) anxiety during exposures. This poster will further discuss how clinicians can use the data regarding community practice to evaluate their own use of imaginal exposures in the context of theoretical frameworks for treating childhood anxiety disorders.