Unknown Treatment: The Lack of Awareness about CBT

By Amanda Rosati

According to the DSM-V (2013), anxiety disorders refer to any disorders in which the diagnosed person experiences “excessive fear and anxiety and related behavioral disturbances,” and the varying disorders differ from one another depending upon what causes this fear or anxiety in the individual (p. 189).  A great number of studies have shown that the most effective method of treatment for these disorders is exposure-based treatment, either on its own or as part of cognitive behavioral therapy (CBT), through which the sufferer is slowly brought into contact with what he or she is afraid of (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Not only have we seen the effects of exposure-based therapy in efficacy studies and clinical studies, but when comparing it to SSRI medication and psychotherapy as treatments for anxiety disorders, exposure-based CBT has proven to be the most superior form of treatment (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).

“Only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting”

More surprising though is the finding that most adults in the United States haven’t even heard of this type of treatment, and furthermore only up to 11% of adults with anxiety disorders receive the kind of treatment they should be getting.  These adults don’t know about exposure-based CBT, and as a result end up spending more on costly pharmacological treatments instead, even though a psychosocial treatment like exposure-based CBT would prove to be the most cost-effective route to take (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Just as well, in all studies thus far that have taught adults about various anxiety disorder treatments, there has consistently been a majority whom have expressed preference toward exposure-based psychosocial approaches rather than pharmacological approaches, further reinforcing the need to spread information about the effectiveness, in terms of both cost and outcome, of exposure-based cognitive behavioral therapy (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  What we see here then is that most adults in the United States who are receiving treatments for anxiety disorders are undergoing treatments which have proved less effective than others because these people haven’t learned about anything that would work better for them in regards to money and outcome.

Wolitzky-Taylor and colleagues looked at the electronic medical records at the Los Angeles Adult Outpatient Psychiatry Clinic over the span of six months in order to see just how much exposure-based CBT was used as treatment for people with anxiety disorders who have low incomes and go to a large community mental health center (2015).  This facility was chosen because it reflected other clinics like it due to its urban location and its patient diversity, though it may have more professionals trained in CBT than the average community clinic since about 75% of the staff has had basic CBT training and supervision before. But even in a clinic with an unusually high number of clinicians trained in cognitive behavioral therapy, less than 4% of all 582 patients diagnosed with anxiety disorders in that six-month period received one session or more of exposure-based treatments (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Despite being present in a setting where CBT training was found to be more prevalent than in most other community clinics, it was still only a minority of patients who were receiving this type of treatment—we can understand from this that the average clinic is thus providing even less cognitive behavioral therapy to other patients nationally.

For the approximate 4% of the total patients in the Los Angeles County AOPC receiving treatment for anxiety disorders, those who did get exposure-based CBT were not receiving a dose that would be enough to help treat their disorders, meaning that they were not attending as many sessions as recommended based on past studies conducted (Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).  Since patients aren’t going to the recommended amount of sessions, which would be between ten and sixteen of them, the clinicians need to work out a plan for each patient that would best utilize the amount of time that he or she does have in order to get optimal results.

The researchers found that, in regards to the total 582 patients receiving treatment for anxiety disorders, almost 90% of the patients were offered pharmacological treatment for their anxiety disorder, and that almost 90% of those accepted this treatment.  Just as well, almost 70% of the patients were offered a non-CBT type of psychotherapy, and almost all of these patients accepted that treatment.  These treatments are less effective than exposure-based cognitive behavioral therapy, in terms of both cost and outcome, and patients with anxiety disorder are neither being presented with the option of receiving CBT nor bringing up the option themselves.  Information about this type of treatment for anxiety disorders needs to be better distributed amongst adults with anxiety disorders so that they can get the right kind of treatment and get on the best track toward improved health.

References

Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, & E., Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9-17.