The Exposure Guide: A Practical Measure of Exposure Quality

Quality monitoring is essential for the use of evidence-based interventions (EBIs) in both practice and research settings, yet few quality measures have been developed or validated for any treatment. This study examined the initial psychometric properties of a brief, practical measure of quality for exposure therapy (Exposure Guide; EG) in a sample of youth from three randomized clinical trials for pediatric OCD (N = 103 patients and 368 sessions). The EG was initially developed based on the behavioral principles underlying exposure, delivery factors linked to clinical outcomes in prior literature, and with input from both exposure therapy researchers and partners in community mental health settings. Results indicated good to excellent inter-rater reliability (item ICCs = .64 to 1.00). When compared against a validated, time-intensive coding system, each EG item exhibited large correlations with parallel coding system variables; these were significantly larger than correlations with other variables. Variance components analysis demonstrated EG subscale variability at the level of therapists, patients, and time. The EG demonstrates strong initial reliability and construct validity in a clinical trial context; future studies will be needed to establish psychometric properties in practice settings and to elucidate therapist, patient, and treatment course factors that may influence quality.