Clinical Round Table 3 - Call-to-action: Recognizing and Correcting Marginalization in Exposure Therapy Practice

Despite advances in the psychology field aimed at addressing and correcting its historical participation in the marginalization of minoritized groups, areas for improvement remain. In particular, current accepted practices of exposure therapy, a gold standard treatment for a variety of anxiety- and fear-based conditions, often lack a justice-based approach in which implications for historically marginalized groups are considered (Pinciotti et al., 2022). For example, obsessive-compulsive disorder (OCD) can involve themes related to sexual orientation, gender identity, race, and ability status, leading many clinicians to encourage exposure activities that reinforce harmful stereotypes, stigmatize non-dominant identities, and normalize disgust and repulsion of marginalized individuals. Individuals who hold marginalized identities experience fear and engage in adaptive avoidance in social settings, which carry the risk of rejection and physical harm, yet are commonly misdiagnosed with social anxiety and prompted to engage in socially assertive behaviors when it may not be safe or necessary to do so. Clinicians treating individuals with health anxiety focused on disability status may design exposures that propagate stereotypes about individuals with disabilities or reinforce the notion that living with a disability is not a life worth living. Exposure therapy for eating disorders can target fears rooted in the anti-fat bias prevalent in our society (e.g., weight gain and social judgment or rejection, criticism of body shape or eating habits, harmful stereotypes associated with larger bodies) and can risk reinforcing themes of weight stigma and disgust toward larger bodies. This roundtable represents a crucial call-to-action for the field of psychology by identifying common pitfalls in the implementation of exposure therapy and discussing updated, justice-based recommendations for improving care so that all impacted persons—client, provider, and society—are considered and respected. Panel members share a breadth of expertise in exposure therapy for OCD, social anxiety, health anxiety, and eating disorders, and will discuss recommendations to enhance these conceptual frameworks to be more culturally affirming.