Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)



First Advisor

Hilary B Vidair


Generalized anxiety disorder (GAD) is challenging to treat; only approximately 50% of patients have been identified as having meaningful anxiety symptom reduction, with high relapse rates (e.g., Borkovec et al., 2002; Rapgay, Bystritsky, Dafter, & Spearman, 2011). Imaginal exposure (IE) has been shown to decrease behavioral avoidance of emotions as well as anxiety symptoms (Fracalanza, Koerner, & Antony, 2014; Hoyer & Beesdo-Baum, 2012), yet clinicians often do not use exposure treatments due to their attitudes about evidence-based practice, treatment preferences, and beliefs about client discomfort (e.g., Harned, Dimeff, Woodcock, & Contreras, 2013; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014; Whiteside, Deacon, Benito, & Stewart, 2016). This study sought to determine if there were differences in the types of CBT approaches that psychologists (N = 244) accept, prefer, and use to treat GAD in practice as well as to assess clinicians’ beliefs about IE. Participants read two case vignettes, one using IE and one using cognitive restructuring and relaxation training (CRRT), to treat a potential client with GAD. Results showed that participants found both treatments moderately acceptable, but were significantly more likely to prefer and use CRRT techniques. Psychologists who endorsed obtaining more exposure-specific training and receiving CBT-oriented post-doctoral training were significantly more likely to accept, prefer, and use IE than other psychologists. Those who reported attending a more CBT-oriented graduate program were more likely to use IE than those who attended a less CBT-oriented graduate program. More negative beliefs about IE were significantly positively correlated with preference and use of CRRT, although psychologists who obtained more exposure-specific training and attended CBT-oriented post-doctoral training endorsed fewer negative beliefs about IE. This study’s findings point to a need to educate clinicians about the benefits of IE for GAD.