Category: Dissemination / Implementation
Timely dissemination of evidence-based practices for treating mental disorders is a world-wide priority. The purpose of this study is to identify the current state of dissemination of evidence-based practice, especially for cognitive behavioral therapy (CBT) for several mental disorders, and highlighting some barriers inhibiting the implementation of CBT at the community mental health clinics. We send a survey form by direct mail to the entire universe of 6,265 psychiatric clinics across Japan. We received a response rate of 16.5% (n=1,019). As a result, 66.0% (n=650) of participating clinics have experienced patients requesting CBT and 37.9% (n=386) of participating clinics have introduced CBT in their practice. This represents 6.2% of all psychiatric clinics in Japan. Among those clinics which introduced CBT, a high rate of CBT utilization was observed for Major Depressive disorder (81.2%), Social Anxiety Disorder (71.9%), Panic Disorder (71.3%), Generalized Anxiety Disorder (67.4%), and Obsessive/Compulsive Disorder (64.3%), while low rate was observed for Alcohol Use Disorder (18.0%), Schizophrenia (20.3%), Borderline Personality Disorder (24.3%), and Anorexia Nervosa (27.3%). Additionally, among those clinics offering CBT, 79.5% (n=307) also used other psychotherapy treatments, such as interpersonal psychotherapy, family therapy, or humanistic therapy. The reported difficulties in providing CBT at the community mental health clinics were as follows: (a) Less cost-effective vs medication therapy, (b) Lack of adequate time to spend with patient, (c) Limited opportunity for developing CBT skills, and (d) that the therapist supports some kind of therapy orientation other than CBT. Because all clinics participated in this study were located in Japan, we should not project these findings to other countries. This study, however, identify several focus areas that should be investigated and further tested regarding treatment delivery and dissemination.
Fumito Takahashi– , Shinshu University, Nagano, Nagano, Japan