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

Abstract

Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.

Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study

“…With the involvement of clinicians and other actors involved in demand management, and most importantly, with enough input from service users with lived experience of anxiety disorders, services analysis using our model would provide some of the information needed to ensure that any redesign or restructuring accounts for the access-related challenges that patients actually face and overcome. Utilizing our model in this fashion would enable the leveraging, within demand management strategies, of continually improving access-oriented CBT delivery modalities, notably using technologies to bypass physical, financial, or sigma-related barriers ( 20 ).…”

“…Psychological interventions targeting anxiety disorders are generally based on cognitive-behavioral therapy (CBT) principles and techniques, including modalities such as individual psychotherapy delivered by CBT specialists, group psychotherapy, guided internet-based interventions, and self-directed treatment packages ( 15 ). While the diversity of evidence-based CBT delivery modalities creates new opportunities to make those treatments more available ( 20 ), this is not a sufficient condition to guarantee access to everyone.…”

“…In addition to treatment availability, access requires the perception of needs and desire for care, health care seeking, the ability to afford health care utilization, and the ability to engage appropriate services, all of which can be considered from the perspective of either supply- or demand-side actors ( 21 ). Adopting this multidimensional perspective, a scoping review on improving access to CBTs for anxiety disorders has found six types of strategies from the thematic analysis of 94 published documents: contributing to the evidence base, identifying CBT delivery modalities to adopt in practice, building capacity for CBT delivery, attuning the process of access to local needs, engaging potential service users, and improving programs and policies ( 20 ). This review highlighted that actors who may contribute to improving access are diverse and should be targeted by strategies fitting their situation.…”

Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial

“…Exposure therapy can be further explained as a series of psychological treatment strategies that aims to reduce pathological fears commonly found in people with anxiety disorders. Systematic desensitization is usually considered a form of behavioral or cognitive-behavioral therapy (CBT) ( 6 ). Furthermore, CBT techniques could be used in the treatment of chronic pain, cancer, and other severe conditions such as stroke and could help in enhancing physical and mental abilities while reducing undesirable behaviors ( 7 ).…”

Australian men's help-seeking intentions for anxiety symptoms: The impact of masculine norm conformity and gender role conflict

“…Mental health help-seeking can be sought from informal sources such as friends and family, or from formal sources such as psychologists, counsellors, or general practitioners [ 31 ]. There is strong indication that evidence-based psychological treatment provided by mental health professionals (i.e., formal help-seeking) can greatly aid recovery from psychological illness [ [32] , [33] , [34] ].…”