# Quality Assessment in Exposure Therapy

> **NIH NIH R01** · EMMA PENDLETON BRADLEY HOSPITAL · 2020 · $407,313

## Abstract

Project Summary/Abstract
Empirically supported behavioral treatments cannot be effectively disseminated without
understanding key quality components. Mechanism-informed quality measures have
extraordinary potential to enhance pragmatism by eliminating unnecessary elements and
targeting multiple problems and populations, and to enhance predictive value by detecting
mechanism engagement early in treatment. Community Mental Health Agencies (CMHAs),
however, are often ill-equipped to use such measures of treatment quality due to burden and
limited resources. Exposure therapy for anxiety is an ideal prototype for testing a practical,
mechanism-informed quality measure in CMHAs given its potential for public health impact and
clear theory of mechanism. The Exposure Guide (EG), a brief quality tool measuring therapist
behaviors and mechanism, was developed based on microanalytic coded data showing a strong
link between therapist behavior and patient outcome across three RCTs of exposure therapy in
youth. Initial psychometrics for the EG using these RCT data are promising showing reliability,
construct validity, and predictive validity, and pilot data suggests it may be acceptable and
feasible in a community setting. Building upon these findings, we propose to test this novel
measure of exposure quality, EG, in a community setting including its reliability and validity, its
pragmatism, and which community end-users can become reliable and valid reporters.
Therapists at a large local CMHA (N = 40) treating anxious youth and young adults ages 5-21
(N = 300) will participate in this study. The EG will be completed by 1) agency supervisors
monthly, 2) therapists per session, 3) patient/families per session, and 4) study raters per
session. Results from this study will establish an innovative model for measuring therapeutic
elements that trigger mechanism of change in real-world therapy as well as inform future use of
EG as a training tool to improve exposure quality in community settings.

## Key facts

- **NIH application ID:** 9915967
- **Project number:** 5R01MH112516-04
- **Recipient organization:** EMMA PENDLETON BRADLEY HOSPITAL
- **Principal Investigator:** Kristen G Benito
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $407,313
- **Award type:** 5
- **Project period:** 2017-06-01 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9915967

## Citation

> US National Institutes of Health, RePORTER application 9915967, Quality Assessment in Exposure Therapy (5R01MH112516-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9915967. Licensed CC0.

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