Department of Psychology, University of Sheffield, UK.
Department of Psychology, University of Sheffield, UK.
Behav Res Ther. 2016 Feb;77:157-61. doi: 10.1016/j.brat.2015.12.015. Epub 2015 Dec 29.
Psychological therapists commonly fail to adhere to treatment protocols in everyday clinical practice. In part, this pattern of drift is attributable to anxious therapists being less likely to undertake some elements of evidence-based therapies - particularly the exposure-based elements. This study considers what facets of anxiety (cognitive, behavioral, physiological) are related to junior clinicians' reported use of cognitive-behavioral therapy techniques. Thirty-two clinicians (mean age = 28.9 years; mean length of CBT experience = 1.5 years; 23 female, nine male) who offered CBT were assessed for their cognitive, behavioral and physiological characteristics (Intolerance of Uncertainty scale; risk taking; skin conductance response and heart rate variability). While the three different facets of anxiety were relatively poorly associated with each other, as is usual in this literature, each facet was linked differently to the reported delivery of CBT techniques (P < .05). Overall, higher anxiety levels were associated with a poorer use of exposure methods or with a greater use of other behavioral or cognitive methods. Of the three facets of anxiety, only physiological reactivity showed an association with the clinicians' temporal characteristics, with more experienced therapists being more likely to have greater skin conductance responses to positive and negative outcomes. These findings suggest that clinicians who are more anxious are less likely to deliver the full evidence-based form of CBT and to focus instead on less challenging elements of the therapy. Potential ways of overcoming this limitation are discussed.
心理治疗师在日常临床实践中常常未能遵守治疗方案。部分原因是焦虑的治疗师不太可能采用某些基于证据的治疗方法，尤其是基于暴露的方法。本研究探讨了焦虑的哪些方面（认知、行为、生理）与初级临床医生报告的认知行为治疗技术的使用有关。对 32 名提供认知行为治疗的治疗师（平均年龄 28.9 岁；平均接受认知行为治疗的经验为 1.5 年；23 名女性，9 名男性）进行了认知、行为和生理特征评估（不确定容忍量表；冒险行为；皮肤电导率反应和心率变异性）。虽然焦虑的这三个不同方面彼此之间的相关性相对较差，这在该文献中很常见，但每个方面与报告的认知行为治疗技术的提供方式都有不同的关联（P<.05）。总体而言，较高的焦虑水平与暴露方法的使用较差或其他行为或认知方法的使用较多有关。在焦虑的三个方面中，只有生理反应与治疗师的时间特征有关，经验丰富的治疗师对积极和消极结果的皮肤电导率反应更有可能更大。这些发现表明，焦虑程度较高的治疗师不太可能提供完整的基于证据的认知行为治疗形式，而是更倾向于关注治疗中不那么具有挑战性的元素。讨论了克服这一限制的潜在方法。
