Effects of Therapist Warmth and Self-Disclosure on Exposure Therapy for Acrophobia

Exposure therapy has long been known for its efficacy in treating a wide range of anxiety disorders, including panic disorder, posttraumatic stress disorder, obsessive compulsive disorder, and specific phobias. Despite proven efficacy, exposure therapy is under-utilized as a treatment for anxiety disorders, which effect the general population at a lifetime prevalence rate of approximately 29%. Despite large bodies of research that offer evidenced-based support for exposure therapy, misconceptions continue to persist about exposure being archaic and cruel. Recent research suggests that more studies need to be done to decrease the boundaries around understanding and implementing exposure therapy. Cognitive behavioral therapy literature, as well as transdiagnositic therapy literature, suggests that therapist variables can have a significant impact on treatment adherence and preference. Two of the variables discussed in the literature are therapist warmth and therapist self-disclosure.;The current study examines the effects of therapist warmth and self-disclosure on behavioral engagement, as well as the perception of the therapist, in an acrophobic college population being treated with exposure therapy. This study hypothesized that participants with warm therapists would demonstrate increased behavioral engagement and decreased avoidance of a feared stimulus, as compared to participants with neutral therapists. Participants with warm therapists would also rate their therapists more favorably as compared to participant's with neutral therapists. This study also hypothesized that participants with self-disclosing therapists would demonstrate increased behavioral engagement and decreased avoidance of a feared stimulus as compared to participants with non-self-disclosing therapists. It was further predicted that participant's with self-disclosing therapists would rate their therapists as more favorable than participant's with non-self-disclosing therapists. Lastly, this study hypothesized utilizing a planned comparison that participants with warm and self-disclosing therapists would demonstrate the highest levels of behavioral engagement and therapist as compared to participants with neutral and non-self-disclosing therapists.;Thirty-three undergraduate participants were randomly assigned to four conditions: a warm/disclosing therapist condition, a warm/non-disclosing therapist condition, a neutral/disclosing therapist condition, and a neutral/non-disclosing therapist condition. Following assignment to one of these conditions, participants were guided through a baseline behavioral avoidance task, followed by a 30 minute exposure protocol, and then a post-test repeat of the same behavioral avoidance task. Participants were then asked to fill out self-report data about perceived working alliance with their therapist as well as therapist liking. Following completion of this first session, participants were asked to schedule a second follow-up session at which time they could choose to partake in a second exposure session or be debriefed immediately. Participants were also sent an online homework assignment to complete between sessions as a measure of behavioral engagement. Participants were then debriefed and offered resources for ongoing acrophobia treatment through Hofstra University's Phobia & Trauma Clinic.;Results did not support the hypothesis that participants in the warmth condition would demonstrate greater behavioral engagement and lesser avoidance in the behavioral avoidance task. Upon further analyses, it was indicated that participants in the warmth condition did disclose higher levels of subjective distress than their neutral counterparts. Results did not support therapists in the warmth condition being perceived as more favorable. Results did not support the hypothesis that participants in the self-disclosing condition would demonstrate lesser avoidance and rate their therapists as more favorable than their non-self-disclosing counterparts. However, results did indicate increased behavioral engagement as determined by in-session behavior. Results did not support the hypothesis that participants in the warm and self-disclosing condition would demonstrate the highest levels of behavioral engagement and therapist liking as well as the least amount of avoidance the behavioral avoidance task.;The current study identifies therapist warmth and self-disclosure as meaningful in the context of behavioral engagement and accuracy in reports of subjective distress. This study does not support findings that suggest warm and self-disclosing therapists are considered more likable than other therapists. This study had several limitations, including small sample size, and inconsistency in the validity of measures that may have impacted these results. However, the current study lends itself to the support of previous research that has found therapist warmth and self-disclosure are important variables in decreasing barriers to implementing exposure therapy.