Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review

“…When treatment efficacy is known, researchers can contribute further by conducting "effectiveness" [ 47 – 50 ] or "pragmatic" [ 51 ] studies, with treatment providers, resources, and patients representative of "real-world" contexts [ 11 , 43 , 52 – 54 ]. As an illustration of this approach, some authors invite researchers to be mindful of trials’ exclusion criteria that would lead clinicians to have reasonable doubts about the applicability of the results to their clientele [ 44 , 55 – 59 ]. Because of resource discrepancies, interventions trialed exclusively during experiments [ 44 , 57 , 60 , 61 ] or in the context of a specialized clinic [ 48 , 55 , 62 , 63 ] may need to be tested for transferability to build a case for dissemination.…”

“…As an illustration of this approach, some authors invite researchers to be mindful of trials’ exclusion criteria that would lead clinicians to have reasonable doubts about the applicability of the results to their clientele [ 44 , 55 – 59 ]. Because of resource discrepancies, interventions trialed exclusively during experiments [ 44 , 57 , 60 , 61 ] or in the context of a specialized clinic [ 48 , 55 , 62 , 63 ] may need to be tested for transferability to build a case for dissemination. Providing a more detailed account of crucial information, such as the specific training and supervision procedures employed [ 51 , 64 ], can facilitate replication.…”

“…Several methodological approaches were identified to generate data from existing programs : naturalistic, open, or "phase 4" studies [ 11 , 44 , 45 , 62 , 70 – 72 ], observational studies from routine care [ 73 ], implementation or program evaluation studies [ 49 , 74 – 78 ], and quality improvement research [ 79 ]. While the degree of overlap between these methodologies is beyond this review’s scope, their variety in published studies highlights the recognized importance of learning from existing programs.…”

“…Documents analyzed included reports on existing programs aiming to improve access to CBT for anxiety disorders through treatment modalities such as telephone CBT [ 74 ], internet-delivered CBT [ 70 – 73 , 75 , 77 , 78 ], and transdiagnostic group CBT. Some studies reported on an implemented training program [ 76 ], an approach to collaborative care [ 79 ], or CBT practices in primary care settings [ 44 ]. Other existing programs had the broader aim of improving access to various mental health services (including CBT) through a national-level endeavor [ 81 , 82 ].…”

“…The specific training required to attain competency in CBT delivery depends on both the treatment modality and the trainee’s skills and previous experience [ 46 , 83 , 123 ]. Whatever their background, several authors suggest that clinical supervision is critical to prepare CBT providers for practice [ 11 , 44 , 63 , 85 , 117 , 118 , 124 ]. Training should be congruent with the role trainees are expected to fulfill on the field, covering new delivery modalities such as remote CBT and self-guided treatments [ 69 , 71 , 74 , 81 , 82 , 92 , 98 ] and the specifics of managing in vivo or virtual reality exposure in a clinical setting [ 43 , 89 , 125 ].…”