To deliver or not to deliver cognitive behavioral therapy for eating disorders: Replication and extension of our understanding of why therapists fail to do what they should do.
OBJECTIVE
This study investigated the extent to which therapists fail to apply empirically supported treatments in a sample of clinicians in The Netherlands, delivering cognitive behavioral therapy for eating disorders (CBT-ED). It aimed to replicate previous findings, and to extend them by examining other potential intra-individual factors associated with the level of (non-)use of core CBT-ED techniques.


METHOD
Participants were 139 clinicians (127 women; mean age 41.4 years, range = 24-64) who completed an online survey about the level of use of specific techniques, their beliefs (e.g., about the importance of the alliance and use of pretreatment motivational techniques), anxiety (Intolerance of Uncertainty Scale), and personality (Ten Item Personality Inventory).


RESULTS
Despite some differences with Waller's (2012) findings, the present results continue to indicate that therapists are not reliably delivering the CBT-ED techniques that would be expected to provide the best treatment to their patients. This 'non-delivery' appears to be related to clinician anxiety, temporal factors, and clinicians' beliefs about the power of the therapeutic alliance in driving therapy outcomes.


DISCUSSION
Improving treatment delivery will involve working with clinicians' levels of anxiety, clarifying the lack of benefit of pre-therapy motivational enhancement work, and reminding clinicians that the therapeutic alliance is enhanced by behavioral change in CBT-ED, rather than the other way around.
['Mulkens|Sandra|S|', 'de Vos|Chloé|C|', 'de Graaff|Anastacia|A|', 'Waller|Glenn|G|']
D000066491:Clinical Decision-Making D015928:Cognitive Behavioral Therapy D001068:Feeding and Eating Disorders D005260:Female D006801:Humans D008297:Male D011613:Psychotherapy D016896:Treatment Outcome D035501:Uncertainty
Cognitive behavior therapy Eating disorders Clinician anxiety Therapeutic alliance Evidence-based practice Therapist drift ‘Non-delivery’