Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T12:02:45.294Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychotherapists’ reports of technique use when treating anxiety disorders: factors associated with specific technique use

Published online by Cambridge University Press:  27 June 2019

Zachary J. Parker Open the ORCID record for Zachary J. Parker [Opens in a new window]  and
Glenn Waller Open the ORCID record for Glenn Waller [Opens in a new window]
Zachary J. Parker*
Affiliation:
Department of Psychology, Manchester Metropolitan University, Manchester, UK
Glenn Waller
Affiliation:
Department of Psychology, University of Sheffield, Sheffield, UK
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitive behavioural therapy (CBT) is the most efficacious and effective psychological intervention for treating anxiety disorders. Behavioural techniques, in particular exposure-based techniques, are fundamental to positive outcomes. However, research suggests that these techniques are either not used or are under-used when treating anxiety disorders. This study assesses therapists’ reported use of CBT techniques in the treatment of anxiety disorders, and explores which therapist variables influence technique use. A total of 173 CBT therapists completed measures on their demographics, routine therapy practices in treating anxiety disorders, and internal states (e.g. self-esteem). These data were analysed to see how often therapists employed particular techniques and the correlates of the use of those techniques. Behavioural techniques (e.g. exposure) were the least utilized set of core CBT skills, being used less often than non-CBT techniques. The under-utilization of these key techniques was associated with greater levels of increased inhibitory anxiety amongst therapists. Supervision and therapists’ self-esteem were both positively associated with the use of non-CBT techniques. While this study established what CBT therapists purport to use in routine practice with anxious populations, further research is needed to assess the association between adherence (or lack thereof) and client outcomes, and the factors that drive non-adherence.

Key learning aims

As a result of reading this paper, the reader should:

  1. (1) Learn about what psychotherapists report as occurring in routine care for individuals with anxiety and related disorders.

  2. (2) Know the potential therapist traits that influence the use of CBT techniques.

  3. (3) Gain knowledge to help explain to clients why previous therapy may not have been effective.

  4. (4) Develop a richer understanding of what factors may influence their own therapeutic practice.

Keywords

evidence-based practicepsychotherapy processservice evaluationtherapist competencetreatment adherence
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e33
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Brosan, L, Reynolds, S, Moore, RG (2008). Self-evaluation of cognitive therapy performance: do therapists know how competent they are? Behavioural and Cognitive Psychotherapy, 36, 581–587. doi: 10.1017/S1352465808004438 CrossRefGoogle Scholar
Stobie, B, Taylor, T, Quigley, A, Ewing, S (2007). ‘Contents may vary’: a pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35, 273–282. doi: 10.1017/S135246580700358X CrossRefGoogle Scholar
Waller, G, Turner, H (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behavior Therapy and Research, 77, 129–137. doi:10.1016/j.brat.2015.12.005 CrossRefGoogle ScholarPubMed

References

Abramowitz, JS, Taylor, S, McKay, D (2012). Exposure-based treatment for obsessive compulsive disorder. In Steketee, G. (ed), The Oxford Handbook of Obsessive Compulsive and Spectrum Disorders (pp. 322–344). New York, NY, USA: Oxford University Press.Google Scholar
Addis, ME, Krasnow, AD (2000). A national survey of practicing psychologists’ attitudes towards psychotherapy treatment manuals. Journal of Consulting and Clinical Psychology, 68, 331–339. doi: 10.1036//0022-006x.68.2 CrossRefGoogle Scholar
Addis, ME, Wade, WA, Hatgis, C (1999). Barriers to dissemination of evidence-based practices: addressing practitioners’ concerns about manual-based psychotherapies. Clinical Psychology, 6, 430–441. doi: 10.1093/clipsy.6.4.430 Google Scholar
American Psychological Association (2003). Ethical Principles of Psychologists and Code of Conduct. Available at: https://www.apa.org/ethics/code/ Google Scholar
Barlow, DH, Craske, MG, Cerny, JA, Klosko, JS (1989). Behavioral treatment for panic disorder. Behavior Therapy, 20, 261–282. doi: 10.1016/S0005-7894(89)80073-5 CrossRefGoogle Scholar
Becker, CB, Zayfert, C, Anderson, E (2004). A survey of psychologists’ attitudes towards and utilization of exposure for PTSD. Behaviour Research and Therapy, 42, 277–292. doi: 10.1016/S0005-7967(03)00138-4 CrossRefGoogle ScholarPubMed
Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214–227.CrossRefGoogle ScholarPubMed
Brosan, L, Reynolds, S, Moore, RG (2006). Factors associated with competence in cognitive therapists. Behavioural and Cognitive Psychotherapy, 35, 179–190. doi: 10.1017/S1352465806003304 CrossRefGoogle Scholar
Brosan, L, Reynolds, S, Moore, RG (2008). Self-evaluation of cognitive therapy performance: do therapists know how competent they are? Behavioural and Cognitive Psychotherapy, 36, 581–587. doi: 10.1017/S1352465808004438 CrossRefGoogle Scholar
Carleton, RN, Norton, MA, Asmundson, GJG (2007). Fearing the unknown: a short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117. doi: 10.1016/j.janxdis.2006.03.014 CrossRefGoogle Scholar
Clark, DA (2007). Cognitive-Behavioral Therapy for OCD (paperback edn). New York, NY, USA: Guilford Press.Google Scholar
Clark, DA, Beck, AT (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice (paperback edn). New York, NY, USA: Guilford Press.Google Scholar
Clark, DM, Ehlers, A, Hackmann, A, McManus, F, Fennell, M, Grey, N, … & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578. doi: 10.1037/0022-006X.74.3.568 CrossRefGoogle ScholarPubMed
Cottraux, J, Note, I, Yao, SN, Lafont, S, Note, B, Mollard, E, Sauteraud, A, Bourgeois, M, Dartigies, JF (2001). A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder. Psychotherapy and Psychosomatics, 70, 288–297.CrossRefGoogle ScholarPubMed
Craske, MG, Barlow, DH (2008). Panic disorder and agoraphobia. In Barlow, DH (ed), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (4th edn, pp. 1–64). New York, NY, USA: Guilford Press.Google Scholar
Deacon, BJ, Farrell, NR, Kemp, JJ, Dixon, LJ, Sy, JT, Zhang, AR, McGrath, PB (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: the Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27, 772–780. doi: 10.1016/j.janxdis.2013.04.006 CrossRefGoogle ScholarPubMed
Dugas, MJ, Fresston, MH, Ladouceur, R (1997). Intolerance of uncertainty and problem orientation in worry. Cognitive Therapy and Worry, 21, 593–606.CrossRefGoogle Scholar
Eddy, KT, Dutra, L, Bradley, R, Westen, D (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clinical Psychology Review, 24, 1011–1030. doi: 10.1016/j.cpr.2004.08.004 CrossRefGoogle ScholarPubMed
Fedoroff, IC, Taylor, S (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology, 21, 311–324.CrossRefGoogle ScholarPubMed
Farrell, NR, Deacon, BJ, Dixon, LJ, Lickel, JJ (2013). Theory-based training strategies for modifying practitioner concerns about exposure therapy. Journal of Anxiety Disorders, 27, 781–787. doi: 10.1016/j.janxdis.2013.09.003 CrossRefGoogle ScholarPubMed
Feske, U, Chambless, DL (1995). Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy, 26, 695–720.CrossRefGoogle Scholar
Foa, EB, Dancu, VC, Hembree, EA, Jaycox, LH, Meadows, EA, Street, GP (1999). A comparison of exposure therapy, stress inoculation training and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Clinical and Consulting Psychology, 67, 194–200.CrossRefGoogle ScholarPubMed
Foa, EB, Hembree, EA, Cahill, SP, Rauch, SAM, Riggs, DS, Feeny, NC, Yadin, E (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964. doi: 10.1037/0022-006X.73.5.953 CrossRefGoogle ScholarPubMed
Franklin, ME, Foa, EB (2008). Obsessive-compulsive disorder. In Barlow, DH (ed), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (4th edn, pp. 164–215). New York, NY, USA: Guildford Press.Google Scholar
Hansen, NB, Lambert, MJ, Forman, EM (2002). The psychology dose–response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 308–327.Google Scholar
Hawkes, LD, Provencher, MD (2011). Schema theory and schema therapy in mood and anxiety disorders: a review. Journal of Cognitive Psychotherapy: An International Quarterly, 25, 257–276.CrossRefGoogle Scholar
Hofmann, SG, Smits, JAJ (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 521–632.Google ScholarPubMed
Kearney, CA (2005). Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and Psychological Treatment. Available at: https://www.springer.com/us/book/9780387225913 CrossRefGoogle Scholar
Khawaja, NG, Lai, NH (2010). A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clinical Psychologist, 14, 97–106. doi: 10.1080/13284207.2010.502542 CrossRefGoogle Scholar
Koch, EI, Gloster, AT, Waller, SA (2007). Exposure treatments for panic disorder with and without agoraphobia. In Richard, DS, and Lauterbach, D (eds), Comprehensive Handbook of Exposure Therapies. New York,NY, USA: Academic Press.Google Scholar
Ladouceur, R, Gosselin, P, Dugas, MJ (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behaviour Research and Theory, 38, 933–941.CrossRefGoogle Scholar
Levita, L, Salas Duhne, PG, Girling, C, Waller, G (2016). Facets of clinicians’ anxiety and the delivery of cognitive behavioral therapy. Behaviour Research and Therapy, 77, 157–161. doi: 10.1016/j.brat.2015.12.015 CrossRefGoogle ScholarPubMed
Martin, B (2013). Treatment of anxiety. In Low intensity cognitive behaviour therapy: A practitioner’s guide (pp. 218–252). Los Angeles, USA: Sage.Google Scholar
Meehl, PE (1986). Causes and effects of my disturbing little book. Journal of Personality Assessment, 50, 370–375.CrossRefGoogle ScholarPubMed
Metalsky, GI, Joiner, TE, Hardin, TS, Abramson, LY (1993). Depressive reactions to failure in a naturalistic setting: a test of the hopelessness and self-esteem theories of depression. Journal of Abnormal Psychology, 102, 101–109.CrossRefGoogle Scholar
Meyer, JM, Farrell, NR, Kemp, JJ, Blakey, SM, Deacon, BJ (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49–53. doi: 10.1016/j.brat.2014.01.004 CrossRefGoogle ScholarPubMed
Norton, PJ, Price, EC (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease, 195, 521–531.CrossRefGoogle ScholarPubMed
Olantunji, BO, Deacon, BJ.,Abramowitz, JS (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioural Practice, 16, 172–180. doi: 10.1016/j.cbpra.2008.07.003 CrossRefGoogle Scholar
Öst, LG (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1–7.CrossRefGoogle ScholarPubMed
Otto, MW, Pollack, MH, Maki, KM (2000). Empirically supported treatments for panic disorder: costs, benefits, and stepped care. Journal of Consulting and Clinical Psychology, 68, 556–563. doi: 10.1037/0022-006X.68.4.556 CrossRefGoogle ScholarPubMed
Parker, ZJ, Waller, G (2015). Factors related to psychotherapists’ self-assessment when treating anxiety and other disorders. Behaviour Research and Therapy, 66, 1–7. doi: 10.1016/j.brat.2014.12.010 CrossRefGoogle ScholarPubMed
Parker, ZJ, Waller, G (2017). Development and validation of the Negative Attitudes towards CBT Scale. Behavioural and Cognitive Psychotherapy, 45, 629–646. doi: 10.1017/S1352465817000170 CrossRefGoogle ScholarPubMed
Resick, PA, Monson, CM, Rizvi, SL (2008). Posttraumatic stress disorder. In Barlow, DH (ed), Clinical Handbook of Psychological Disorders: A Step-By-Step Treatment Manual (4th edn, pp. 65–122). New York, NY, USA: Guilford Press.Google Scholar
Rosenberg, M (1965). Society and the Adolescent Self-Image. Princeton, NJ, USA: Princeton University Press.CrossRefGoogle Scholar
Sánchez-Meca, J, Rosa-Alcázar, AI, Marín-Martínez, F, Gómez-Conesa, A (2010). Psychological treatment of panic disorder with or without agoraphobia: A meta-analysis. Clinical Psychology Review, 30, 37–50. doi: 10.1016/j.cpr.2009.08.011 CrossRefGoogle ScholarPubMed
Schmitt, DP, Allik, J (2005). Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89, 623–642. doi: 10.1037/0022-3514.89.4.623 CrossRefGoogle ScholarPubMed
Simpson-Southward, C, Waller, G, Hardy, GE (2016). Supervision in the treatment of depression: an experimental study of the role of therapist gender and anxiety. Behaviour Research and Therapy, 77, 17–22. doi: 10.1016/j.brat.2015.11.013 CrossRefGoogle ScholarPubMed
Simpson-Southward, C, Waller, G, Hardy, GE (2017). How do we know what makes for ‘best practice’ in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches. Clinical Psychology & Psychotherapy, 24, 1228–1245. doi: 10.1002/cpp.2084.CrossRefGoogle Scholar
Sinclair, SJ, Blais, MA, Gansler, DA, Sandberg, E, Bistis, K, LoCicero, A (2010). Psychometric properties of the Rosenberg Self-Esteem Scale: overall and across demographic groups living within the United States. Evaluation and the Health Professions, 33, 56–80. doi: 10.1177/0163278709356187 CrossRefGoogle ScholarPubMed
Stobie, B, Taylor, T, Quigley, A, Ewing, S (2007). ‘Contents may vary’: a pilot study of treatment histories of OCD patients. Behavioural and Cognitive Psychotherapy, 35, 273–282. doi: 10.1017/S135246580700358X CrossRefGoogle Scholar
Turk, CL, Heimberg, RG, Magee, L (2008). Social anxiety disorder. In Barlow, DH (ed), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (4th edn, pp. 123–163). New York, NY, USA: Guilford Press.Google Scholar
Turner, H, Tatham, M, Lant, M, Mountford, VA, Waller, G (2014). Clinicians’ concerns about delivering cognitive-behavioural therapy for eating disorders. Behaviour Research and Therapy, 57, 38–42. doi: 10.1016/j.brat.2014.04.003 CrossRefGoogle ScholarPubMed
Waller, G (2009). Evidence-based treatment and therapist drift. Behaviour Research and Theory, 47, 119–127. doi: 10.1016/j.brat.2008.10.018 CrossRefGoogle ScholarPubMed
Waller, G, Stringer, H, Meyer, C (2012). What cognitive behavioral techniques do therapist report using when delivering cognitive behavioral therapy for eating disorders? Journal of Consulting and Clinical Psychology, 80, 171–175. doi: 10.1037/a0026559 CrossRefGoogle Scholar
Waller, G, Turner, H (2016). Therapist drift redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behavior Therapy and Research, 77, 129–137. doi: 10.1016/j.brat.2015.12.005 CrossRefGoogle ScholarPubMed
Westen, D, Morrison, K (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875–899.CrossRefGoogle ScholarPubMed
Whittal, ML, Robichaud, M (2012) Cognitive treatment for OCD. In Steketee, G (ed), The Oxford Handbook of Obsessive Compulsive and Spectrum Disorders (pp. 345–364). New York, NY, USA: Oxford University Press.Google Scholar
Zlomke, K, Davis, TE (2008). One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behavior Therapy, 39, 207–223. doi: 10.1016/j.beth.2007.07.003 CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.