Clinical experiences in conducting cognitive-behavioral therapy for social phobia
Abstract
Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.
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We routinely attribute our decisions to deviate from protocol-driven evidence-based practice to the patient or to circumstances, rather than to ourselves.
“Broadly speaking, we routinely attribute our decisions to deviate from protocol-driven evidence-based practice to the patient (e.g., lack of motivation, resistance, severity of symptoms) or to the circumstances (e.g., logistical problems), rather than to ourselves”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as McAleavey et al., 2014
There are substantial inter-therapist differences in how CBT is delivered across a range of disorders, even where the methods are widely available and well known.
“there are substantial inter-therapist differences in how CBT is delivered across a range of disorders, even where the methods are widely available and well known”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as McAleavey, Castonguay & Goldfried, 2014
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- Authors
- McAleavey, A. A., Castonguay, L. G., & Goldfried, M. R.
- Affiliations
- Pennsylvania State University (US)
- Stony Brook University (US)
- Corresponding author
- McAleavey, Andrew A.
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 45
- Issue
- 1
- Pages
- 21-35
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W2053744612
- Cited by
- 42
- References
- 80
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 8 · 2014: 2 · 2013: 2
- FWCI
- 7.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- social anxiety disorder, cognitive behavioral therapy, patient motivation, comorbidities, exposure therapy, patient resistance, research-practice gap, clinical guidelines
- MeSH terms
- Health Personnel, Humans, Phobic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Health Care Surveys, Evidence-Based Practice
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