1 - (OP11) Dimensions of Therapist Beliefs About Exposure: Psychometric Validation of a Dutch Adaptation of the Therapist Beliefs About Exposure Scale (TBES)

Background:
Despite the strong empirical support for exposure therapy in treating anxiety-related and trauma-related disorders, its clinical underutilization remains a persistent concern. One key barrier is therapists’ negative beliefs about the safety, tolerability, and ethicality of exposure, which can lead to less frequent or suboptimal use. The Therapist Beliefs about Exposure Scale (TBES) was developed to assess these attitudes, but no validated version currently exists for Dutch-speaking clinicians. This study aimed to psychometrically validate a Dutch adaptation of the TBES.

Methods:
We obtained data from 206 Dutch and Flemish therapists, with 97 Dutch and 109 Flemish participants in the subsamples. Analyses included reliability assessments, exploratory and confirmatory factor analyses, convergent validity assessments with conceptually related constructs (i.e., anxiety sensitivity, experiential avoidance, intolerance of uncertainty, therapist distress), and criterion validity (i.e., TBES scores predicting self-reported exposure use).

Results:
The Dutch version of the TBES demonstrated good reliability and fit with a three-factor structure, capturing domains reflecting moral reservations and professional boundaries, concerns about client fragility, and expectations of client refusal. Higher TBES scores were significantly and positively associated with therapist anxiety sensitivity, experiential avoidance, therapist distress, and significantly predicted lower self-reported use of exposure therapy across both subsamples.

Conclusions:
These findings support the Dutch TBES as a valid and reliable measure and underscore the need to address clinician beliefs to improve dissemination and implementation of exposure therapy. These findings will help to inform targeted therapist training programs, ultimately improving therapist confidence and exposure use to enhance treatment outcomes for patients with anxiety- and trauma-related disorders.