Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy

Levita, Liat; Duhne, Paulina Gonzalez Salas; Girling, Carla; Waller, Glenn

doi:10.1016/j.brat.2015.12.015

Cited by 30 publications

(31 citation statements)

References 26 publications

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“…Moreover, since the research setting specialized in the treatment of anxiety disorders, the therapists in this setting may have had more specialized training. If the therapists in the practice settings did have less experience in delivering cognitive-behavioral interventions, the therapists may have been more reluctant to use certain interventions, such as exposures, that can be difficult to deliver (Levita, Duhne, Girling, & Waller, 2016). It is also possible that as treatment progressed the YAS-ICBT therapists tended to default to more familiar interventions (Becker, Zyfert, & Anderson, 2004; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014).…”

Section: Discussionmentioning

confidence: 99%

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

et al. 2017

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Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy–Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.

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Section: Discussionmentioning

confidence: 99%

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

et al. 2017

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“…For example, Gibbons, Wiltsey Stirman, DeRubeis, Newman, and Beck (2013) reported that depressed individuals treated with cognitive therapy in a randomized controlled trial environment experienced a three-fold greater reduction in depressive symptoms, compared with similar people treated by the same therapists in a clinical setting. Such gaps between science and practice in psychotherapy have been variously attributed to differences in clinician training (Royal College of Psychiatrists, 2013), failure to adhere to standardized treatment protocols (Levita, Salas Duhne, Girling, & Waller, 2016), or "therapist drift," wherein clinicians become less effective over time (Waller, 2009). Personality characteristics of the anxious or depressed individuals themselves have been identified as a challenge to the clinical application of evidence-based psychotherapies.…”

Section: Introductionmentioning

confidence: 99%

Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression: A Retrospective Study

White¹,

Groeneveld²,

Tittle³

et al. 2017

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Introduction.Neurofeedback (NFB) and heart rate variability (HRV) training present promising, nonpharmaceutical intervention strategies for anxiety and depression. This report is the first to address whether concurrent NFB and HRV (NFB+HRV) provides a viable intervention for symptoms of anxiety and depression, measured by the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire. Methods. 183 children and adults with symptoms of anxiety and/or depression underwent NFB+HRV training. Psychological symptom rating, EEG, blood pressure, breathing pattern, and HRV were measured before and after treatment. Results. After NFB+HRV training, symptoms of anxiety (p < .001, d z = 1.42) and depression (p < .001, d z = 1.34) were reduced in children and adults. The majority of individuals with pretreatment symptoms of anxiety (82.8%) or depression (81.1%) experienced ASEBA improvements of clinical importance. There were also significant changes in EEG, breathing rate, and HRV. For the 16 individuals copresenting with hypertension, systolic and diastolic blood pressure were significantly reduced. Conclusion. We present evidence that NFB+HRV training may provide an effective, nonpharmaceutical intervention to reduce symptoms of anxiety and depression in children and adults. Additionally, NFB+HRV training may improve EEG, blood pressure, resting breathing rate, and HRV.

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“…Students therefore may have had insufficient practice with disorder-specific cases and hence, less opportunity to gain competence. It might also reflect student trepidation to use interventions that entail exposure to anxiety-provoking situations (Levita, Salas Duhne, Girling, & Waller, 2016) which are more likely to be needed in the treatment of specific anxiety disorders. At the same time, it is important to note that CTAD's disorder-specific subsamples were not independent of each other, so conclusions about students' comparative performance with different disorders need to be held tentatively.…”

Section: Study 3 Discussionmentioning

confidence: 99%

Outcome benchmarks for cognitive behaviour therapy delivered by student psychologist training clinics

Smout

Harris

Furber

2019

Australian Psychologist

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Objective To provide outcome benchmarks for evaluating student psychologist‐led training clinics providing outpatient adult cognitive behaviour therapy (CBT) for high prevalence disorders, and illustrate their application to the evaluation of a South Australian community mental health‐based psychology training clinic: The Centre for Treatment of Anxiety and Depression (CTAD). Method Study 1 derived aggregated uncontrolled effect sizes and clinically significant change rates for the CBT and control conditions of randomised controlled trials (RCTs), with critical values for demonstrating equivalence to RCTs and superiority to control conditions for anxiety disorders and depression. Study 2 provided benchmarks for demonstrating equivalence, and superiority to other student clinics. Study 3 calculated outcome effect sizes and clinically significant change rates of 342 consecutive CTAD clients allocated to student psychologists between 2009 and 2015, who provided at least two questionnaires, attended at least three sessions and were primarily seen by a student therapist. Aggregated point prevalence estimates of key demographic characteristics of studies contributing to benchmarks were provided. Results RCT CBT produced higher effect sizes than student clinics, but similar rates of clinically significant change. The application of benchmarking to CTAD illustrated that evaluations of student psychologist effectiveness would differ depending on the benchmark used. Conclusion We have provided best‐available benchmarks for evaluating student‐led adult outpatient CBT which we encourage other student clinics to adopt. The benchmarking approach provided a profile of CTAD's strengths and weaknesses. Examples of how benchmark comparisons could be used to inform service improvement were provided.

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Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy

Cited by 30 publications

References 26 publications

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

Combined Neurofeedback and Heart Rate Variability Training for Individuals with Symptoms of Anxiety and Depression: A Retrospective Study

Outcome benchmarks for cognitive behaviour therapy delivered by student psychologist training clinics

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