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 ( 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.