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Although cognitive behavioral therapy (CBT) has been consistently supported as highly efficacious in the management of various anxiety disorders, a significant number of individuals fail to respond to treatment. In this article, the authors present an attempt to operationalize and implement alternative interventions in two cases of CBT non-responsiveness for anxiety management. Both cases were identified as CBT nonresponsive through repeated psychometric assessment of symptoms, and the focus of therapy was shifted to motivational enhancement techniques. These alternative interventions were conceptualized using the Stages of Change Model, which advocates stage-matched interventions based on individual differences in readiness for change. In the first case of generalized anxiety disorder, motivational enhancement interventions were associated with marked improvement in anxiety symptomatology, whereas the second case of social phobia failed to respond to these interventions. Discussion is focused on possible mediators of differential treatment response to motivational interventions with a view to proposing future application and evaluations of these novel techniques.

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Although cognitiveϪbehavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for childhood anxiety disorders, the extent to which these interventions comprise usual care is unclear. This study evaluated the management of childhood anxiety in Ontario within 56 publicly funded community-and hospital-based mental health centers using a population survey. Psychologists and psychiatrists rated the frequency of interventions provided within their settings, with results highlighting only moderate access to evidence-based CBT and SSRI treatments. Exposure, a core component of CBT for anxiety, was underutilized. Usual care most often entailed psychoeducation, relaxation training, and family-based approaches. Consistent with established guidelines, combined interventions were typically used to treat moderate to severe levels of anxiety. Practitioners recommended similar care sequences, with the majority beginning with psychotherapy. Difficulties accessing CBT in publicly funded settings in Ontario may be due to the low number of practitioners with expertise in CBT. Implications for the translation and dissemination of evidence-based treatments into clinical settings are discussed.Substantial empirical data support the use of cognitiveϪbe-havioural therapy (CBT) and pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) in the treatment of childhood anxiety disorders (