Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice.

OBJECTIVE
The goal of the current study is to advance efforts to increase the quality of care for childhood anxiety disorder (CADs) through (1) detailing the content of community-based treatment sessions, (2) exploring the validity of therapist surveys, (3) examining the influence of setting differences, and (4) testing the effects of a technology-based training on use of nonexposure strategies.


METHODS
Thirteen therapists were randomly assigned to technology-based training in the use of exposure therapy or treatment as usual (TAU) for CADs. Therapeutic techniques were coded from 125 community-based treatment sessions.


RESULTS
Consistent with survey responses community therapists spent the majority of session time reviewing symptoms (34% of session time), implementing nonexposure cognitive behavioral therapy (CBT; 36%), and rarely engaged in exposure (3%). An integrated behavioral health setting was associated with greater endorsement of exposure on survey, p < 0.05, although this difference was not significant in session recordings, p = 0.14. Multilevel models indicated that technology-based training that has been shown to increase exposure, also decreased use of nonexposure CBT techniques (2% vs. 29%, p < 0.001).


CONCLUSION
The study supports the validity of survey-based findings that community-based care for CADs consists of non-exposure CBT techniques. Efforts should be invested in dissemination of within-session exposure.

Using session recordings to understand the content of community-based treatment for childhood anxiety disorders and response to technology-based training.

Adaptations of an Integrated Behavioral Health Program During COVID-19.

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.

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

This chapter provides an overview of the current evidence supporting the use of exposure therapy for eating disorders. Although further research is needed (because the existing research base is relatively small compared to large exposure literature for anxiety disorders), exposure is an effective approach for addressing key transdiagnostic features in eating disorders, including eating-related fear and avoidance, body image anxiety, compulsive body checking and avoidance, and binge-eating and purging behaviors. Results are drawn from a range of study types, from single case studies to large, methodically rigorous controlled trials. Importantly, several of the studies reviewed in this chapter showed that exposure was helpful for patients who had been previously unable to derive benefit from viable alternative treatments. Thus, exposure may offer a critical “missing element” in treatment protocols that have a reasonably strong evidence base and yet leave room for improvement in outcomes.

Megan K. Wolsey

Papers

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

Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice.