Table 4.
Perceived Patient- and Provider-Level Barriers to Delivering Evidence-Based Treatment for Anxiety Disorders (Provider Survey, n = 95)
| Completely disagree | Somewhat disagree | Neutral | Somewhat agree | Completely agree | |
|---|---|---|---|---|---|
| I think there are better ways to treat anxiety than to use cognitive or behavioral (i.e., exposure, or facing fears) strategies. | 11.6 | 37.7 | 29.0 | 20.3 | 1.4 |
| I think exposure is harmful to patients (e.g., re-traumatizes, is mean, makes them worse). | 17.1 | 31.4 | 32.9 | 15.7 | 2.9 |
| I don’t think exposure works for treating anxiety. | 20.0 | 41.4 | 27.1 | 8.6 | 2.9 |
| I don’t think cognitive restructuring works for treating anxiety. | 34.8 | 40.6 | 17.4 | 4.3 | 2.9 |
| It makes me uncomfortable to make my patients anxious on purpose. | 11.6 | 29.0 | 29.0 | 23.2 | 7.2 |
| I do not feel competent to deliver cognitive restructuring. | 30.0 | 37.1 | 15.7 | 12.9 | 4.3 |
| I do not feel competent to deliver exposure therapy. | 17.1 | 28.6 | 12.9 | 25.7 | 15.7 |
| My supervisor does not know how to do cognitive restructuring well enough for me to feel comfortable getting consultation from him or her to use these approaches. | 33.8 | 22.5 | 28.2 | 14.1 | 1.4 |
| My supervisor does not know how to do exposure well enough for me to feel comfortable getting consultation from him or her to use these approaches. | 29.6 | 25.4 | 28.2 | 11.3 | 5.6 |
| I did not receive adequate training to deliver cognitive restructuring for anxiety. | 22.9 | 30.0 | 25.7 | 17.1 | 4.3 |
| I did not receive adequate training to deliver exposure therapy for anxiety. | 19.7 | 15.5 | 25.4 | 28.2 | 11.3 |
| My supervisor knows how to deliver cognitive and behavioral strategies for anxiety, but my supervision is not long or frequent enough for me to get the help I need. | 32.4 | 14.1 | 36.6 | 14.1 | 2.8 |
| We focus on other things during supervision, so there is not enough time for me to get help with these cases. | 31.0 | 29.6 | 25.4 | 12.7 | 1.4 |
| It is too difficult to get my patients into weekly or bi-weekly sessions to do a good course of CBT for anxiety. | 29.6 | 23.9 | 26.8 | 19.7 | 0.0 |
| My patients are unwilling or unable to come in for regular appointments. | 26.8 | 26.8 | 25.4 | 14.1 | 7.0 |
| I have offered cognitive therapy to my patients with anxiety disorders, but they usually refuse. | 32.9 | 37.1 | 22.9 | 5.7 | 1.4 |
| I have offered exposure therapy to my patients with anxiety disorders, but they usually refuse. | 25.4 | 32.4 | 31.0 | 8.5 | 2.8 |
| I have offered cognitive therapy to my patients with anxiety disorders, but they usually stop showing up. | 32.9 | 38.6 | 22.9 | 5.7 | 0.0 |
| I have offered exposure therapy to my patients with anxiety disorders, but they usually stop showing up. | 34.3 | 28.6 | 32.9 | 4.3 | 0.0 |
| I feel like I need to handle my patients’ ongoing crises and this takes priority over starting CBT for anxiety. | 14.1 | 22.5 | 26.8 | 31.0 | 5.6 |
| Most of my patients are too complex or severe to benefit from CBT for their anxiety disorder. | 31.0 | 39.4 | 19.7 | 9.9 | 0.0 |
| Most of my patients are not motivated enough to benefit from CBT for their anxiety disorder. | 21.1 | 38.0 | 26.8 | 14.1 | 0.0 |
| Most of my patients are not functioning well enough to benefit from CBT for their anxiety disorder. | 25.4 | 31.0 | 23.9 | 18.3 | 1.4 |
| My patients have more important things to deal with than their anxiety disorder. | 32.9 | 28.6 | 30.0 | 8.6 | 0.0 |
| My supervisor does not like CBT or thinks other therapies are more helpful for anxiety. | 55.7 | 17.1 | 22.9 | 4.3 | 0.0 |
| A successful anxiety treatment is one in which my patient learns to relax, control anxiety, and avoid anxiety-provoking situations. | 15.5 | 19.7 | 18.3 | 29.6 | 16.9 |
| Most of my patients’ anxiety do not conform to a DSM anxiety disorder, so I’m not sure how I would treat it using CBT. | 42.3 | 26.8 | 26.8 | 2.8 | 1.4 |
| It’s hard to know what kind of exposure exercises I could do with my patients, since most of them do not have anxiety that conforms to a typical DSM anxiety disorder. | 39.4 | 28.2 | 26.8 | 5.6 | 0.0 |
| In our clinic, we need to be flexible and deal with a lot of complex issues, so going through a formal manual or structured treatment is not practical. | 21.1 | 18.3 | 29.6 | 25.4 | 5.6 |
| I am not aware of flexible ways to apply cognitive and behavioral strategies to anxiety problems. | 39.4 | 32.4 | 15.5 | 8.5 | 4.2 |