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

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 aimsAs a result of reading this paper, the reader should: (1)Learn about what psychotherapists report as occurring in routine care for individuals with anxiety and related disorders.(2)Know the potential therapist traits that influence the use of CBT techniques.(3)Gain knowledge to help explain to clients why previous therapy may not have been effective.(4)Develop a richer understanding of what factors may influence their own therapeutic practice.

Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary

“…There are multilevel barriers to exposure therapy implementation (26). However, the most robust predictors of exposure therapy's underutilization and suboptimal delivery include: (1) clinicians' negative beliefs, such as concerns about iatrogenic effects [e.g., (27,28), and (2) clinicians' own affective experiences, such as anxiety about delivering the intervention (29)(30)(31)(32)(33). For example, clinicians who experience more anxiety during delivery of exposures are more likely to discontinue an exposure prematurely or coach the patient to engage in contraindicated arousal reduction strategies (e.g., deep breathing, progressive muscle relaxation) that undermine the intended goal of the exposure (30,31).…”

Attitudes and applications of chairwork amongst CBT therapists: a preliminary survey

“…For example, anxious clinicians tend to favour talk-based strategies (e.g. verbal restructuring) over active interventions such as exposure (Levita et al, 2016;Parker and Waller, 2019). Enactive techniques such as chairwork require both creativity and spontaneity (Moreno, 1987), which can challenge clinicians who favour certainty.…”

Are you sitting (un)comfortably? Action-based supervision and supervisory drift

“…This is likely to be partly related to supervisory drift: that is, the failure to provide the supervision that individuals have been trained to deliver, or a failure to deliver supervision competently. Preliminary research indicates that supervisory drift is not uncommon in CBT (Parker and Waller, 2019;Townend et al, 2002). This is understandable given that many supervisors have received little or no supervisory training, while the numbers of clinicians attending CBTspecific supervisory training or supervisory supervision are likely to be even lower.…”