The role of exposure in treatment of anxiety disorders: a meta-analysis

OBJECTIVE: This meta-analysis aimed to determine the overall effect that psychotherapy has on anxiety disorders and to determine what moderates that effect. Studies were grouped by type (efficacy or effectiveness) and grouped by analysis type (completer or intent-to-treat). METHOD: Medline was searched for articles published between 2011 and 2014 that related to the treatment of anxiety disorders. An initial search revealed 8056 articles. Of these, 99 articles met inclusion criteria and were included in the final analyses. RESULTS: Overall, manualised psychotherapy outperformed control conditions. In general, psychotherapy for anxiety disorders had a large effect. This effect appeared to be moderated by the use or lack of use of exposure techniques, with greater effects if exposure was used. This finding held particularly true for the treatment of post-traumatic stress disorder. CONCLUSION: Psychotherapies for anxiety disorders are both efficacious and effective. Exposure techniques enhance the effect of therapies. Future research work is required to determine what else moderates the effect of such therapies

Mental Health Professionals use of Evidence Based Practice: Does the Theory of Planned Behaviour aid our understanding, and is training in Implementation Intentions effective?

Mental health professionals (MHPs) do not routinely deliver evidence-based practice (EBP) despite significant efforts aiming to identify the best available evidence and to disseminate research findings. This thesis aimed to contribute to bridge the research-practice gap by conducting a meta-analysis and two empirical studies. The first part of this thesis reports on a meta-analysis, reviewing 11 studies. This meta-analytic study evaluated the relationship between the Theory of Planned Behaviour (TPB), intentions and behaviours towards using EBPs in MHPs. The TPB determinants (i.e., attitudes, subjective norms and perceived behavioural control) had moderate to strong sample-weighted average relationships with MHPs intentions to use EBPs. Participants’ country at recruitment and client age group were found to moderate the relationship between subjective norms and intentions. Important limitations included the lack of behavioural measures, large inconsistency between studies, and studies’ methodological issues. Implications for clinical practice and recommendations for future research are provided. The second part of this thesis reports two studies. The aim of these studies was to develop and evaluate the feasibility of a training programme for MHPs to prompt their patients to use a particular EBP, implementation intentions. Implementation intentions are self-regulatory strategies that have been shown to help mental health service users to achieve their goals, but MHP do not use this technique routinely in their clinical practice. The first study developed a novel training programme on implementation intentions. The second study evaluated the feasibility of delivering the training to trainee Psychological Well-being Practitioners (TPWPs). In Study 1, a non-systematic review of the literature on implementation intentions and consultation with 25 experts revealed the training content met the criteria established a priori and experts’ feedback was integrated into the training content. In Study 2, 69 TPWPs took part in the training workshop. Participants significantly increased their theoretical and practical knowledge on implementation intentions and reported using implementation intentions significantly more frequently six-months after the training. Three-percent of participants reported using implementation intentions in their clinical practice before the training, compared to 44% of participants six-months after the training. Qualitative analyses revealed participants found the training acceptable and helpful. Specific recommendations were made for future training sessions. Limitations of self-reported measures and lack of observable competence are discussed, along with future research recommendations and potential implications for the Improving Access for Psychological Therapies services. The two parts of this doctoral thesis contribute to the understanding of the use of EBP among MHPs. Findings suggest that attitudes, subjective norms, and perceived behavioural control are useful to understand MHPs intentions to use EBP, and that a single workshop in a particular EBP can influence MHPs’ clinical practice

The role of exposure in treatment of anxiety disorders: a meta-analysis

OBJECTIVE: This meta-analysis aimed to determine the overall effect that psychotherapy has on anxiety disorders and to determine what moderates that effect. Studies were grouped by type (efficacy or effectiveness) and grouped by analysis type (completer or intent-to-treat). METHOD: Medline was searched for articles published between 2011 and 2014 that related to the treatment of anxiety disorders. An initial search revealed 8056 articles. Of these, 99 articles met inclusion criteria and were included in the final analyses. RESULTS: Overall, manualised psychotherapy outperformed control conditions. In general, psychotherapy for anxiety disorders had a large effect. This effect appeared to be moderated by the use or lack of use of exposure techniques, with greater effects if exposure was used. This finding held particularly true for the treatment of post-traumatic stress disorder. CONCLUSION: Psychotherapies for anxiety disorders are both efficacious and effective. Exposure techniques enhance the effect of therapies. Future research work is required to determine what else moderates the effect of such therapies