The feasibility of training general practitioners to do cognitive behavioural therapy in routine practice—A qualitative study

Abstract

Objective In a collaborative care model in Denmark, general practitioners (GPs) were trained in cognitive behavioural therapy (CBT) of their patients with common mental disorders through supervision by psychiatric nurses and a psychiatrist. We explored the feasibility of implementing CBT as a treatment into routine general practice through this supervision. Design A qualitative interview study as part of a larger implementation study of collaborative care between general practice and psychiatry in Denmark. Method Interviews with all three professional groups involved in the intervention were analysed using interpretative phenomenological analysis. Results The participants experienced several cultural and organizational challenges with implementing CBT in general practice. The GPs were used to carrying out talking therapy with methods integrated into the treatment culture in general practice, and it was difficult for them to supplant existing therapeutic skills and approaches. The specific CBT approach was not compatible with the work conditions and work culture in general practice regarding patient relations, time frames and workload; and the inter‐professional training relations between GPs and psychiatric nurses were often challenging. There was an overall agreement among the professionals that general practice of talking therapy could not be changed in the image of psychiatry. Conclusion The results suggest that wide‐scale implementation of CBT delivered by GPs to patients with common mental disorders is not feasible. Nevertheless, there are many psychotherapeutic elements in routine consultations in general practice, and GPs could possibly gain from improving their ways of questioning, and their use of non‐specific therapeutic, relational and psychodynamic factors.

The effects of a structured communication tool in patients with medically unexplained physical symptoms: a cluster randomized trial

“… 1 , 3 , 6 Moreover, the feasibility of implementing CBT in primary care may be constrained by shorter appointment durations and heavy workloads. 7 Therefore, we propose the adoption of a communication tool that integrates a practical framework grounded in CBT principles but specifically tailored to the primary care context.…”