Panel Discussion 3 - Equity in Exposure: Considerations for Modifying Exposures to Meet the Needs of Marginalized and Vulnerable Populations Across the Lifespan

Exposure therapy is an efficacious intervention for anxiety-related disorders and health behaviors, yet equitable access to treatment remains a challenge. This panel will highlight common barriers to exposure delivery among historically marginalized groups (e.g., older adults, racial minorities). Such barriers include clinician concerns about safety and contradiction of eliciting symptoms, limited knowledge, and lack of sensitivity in exposure delivery. Panelists will leverage their varying clinical and research expertise to discuss methods for overcoming barriers, including a justice-based framework, patient tailoring, and guidance for training junior clinicians.

Focus will be given to key considerations for intersectional identities and the use of the justice-based framework, which prioritizes respect and compassion and is designed for those with marginalized identities. As traditional exposures may inadvertently reinforce harmful stereotypes, attendees will gain insight into how this framework supports clinicians in challenging patients’ core maladaptive fears while not invalidating or over-pathologizing their legitimate concerns. Panelists will describe the flexible application of exposure using adapted language and modified activities to increase participant willingness and regular engagement. The important role of dyads in exposure treatment will also be discussed, including children-parents, partners, and medical providers that can shape treatment. Given the known barriers to this evidence-based method (e.g., clinician hesitancy and limited knowledge), it is critical to have robust and structured training for future clinicians to effectively deliver and appropriately tailor exposures for marginalized populations. As such, subject matter experts will highlight methods for training in appropriate exposure modification for particularly vulnerable groups. Additional perspectives will be shared by student clinicians in the effective use of supervision, as well as the development of their own skills in peer supervision and training. This discussion aims to improve the use of exposure in the treatment of marginalized populations to promote equitable dissemination and access to evidence-based care.