Category: Treatment - CBT
Evidence-based practice (EBP) refers to a form of clinical practice that attempts to incorporate the best available research evidence, clinical expertise, and client preferences into clinical decision-making (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Although considerable research has accumulated speaking to the efficacy of various treatments, much less is understood regarding client preferences in the treatment decision-making process. A recent meta-analysis suggested that, in general, prospective clients tend to prefer psychotherapy to medication treatment at a rate of approximately three to one for depressive and anxiety disorders (McHugh et al., 2013). However, in the vast majority of the studies to date, participants have been asked to select between psychotherapy and psychiatric medication with relatively little information regarding the treatment options, such as treatment efficacy, relapse rates at treatment termination, cost involved, and potential unintended consequences (i.e., side effects). The purpose of the present study was to examine treatment preferences for psychotherapy versus medication for two commonly treated anxiety disorders in clinical settings, panic disorder and social anxiety disorder, when information relevant to the treatment decision-making process is and is not provided. A sample of over 500 participants was recruited via MTurk and assigned to receive either information or no information regarding treatment options. Participants were provided descriptive scenarios of panic disorder and social anxiety disorder symptomology, and asked to imagine that upon reporting such concerns to their health care provider, the provider offered two treatment options (i.e., cognitive behavioral therapy or fluoxetine/alprazolam) for them to consider. Participants assigned to the information condition received information regarding treatment efficacy, response rate, treatment duration, treatment cost, relapse rate, and common alternative effects for each intervention. The information provided was derived from evidence contained in meta-analyses on the respective treatments. Results indicated that when relevant treatment information was provided, participants preferred CBT to medication treatment for panic disorder (86% to 14%) and social anxiety disorder (95% to 5%) at a significantly rate than when such information was not provided (panic = 70% to 30%; social anxiety = 79% to 21%; all p’s < .01). Participants reported that response rate, treatment cost, and potential alternative effects most strongly influenced their treatment selection. These findings confirm previous research indicating that most prospective clients for mental health services prefer CBT over medications to treat anxiety problems. However, prospective clients prefer CBT even more strongly when relevant information about the probability of treatment effects, costs, and unintended consequences are provided. The implications of these findings for healthcare providers and evidence based practice will be discussed.
Joshua Broman-Fulks– Professor, Appalachian State University, Boone, North Carolina
Sarah White– Appalachian State University
Corey Kundert– Appalachian State University
Taylor Szucs– Appalachian State University
Kelsey Thomas– Graduate Student, Appalachian State University, Boone, North Carolina