title: Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings?
abstract: Cognitive behavioral therapy (CBT), particularly when it includes an exposure component, is an empirically supported psychosocial treatment for anxiety disorders that has been shown to be highly efficacious, desirable to patients, and cost-effective. However, access to and receipt of exposure-based treatment CBT anxiety remains lacking despite these benefits. The current study reviewed electronic medical records at a large public outpatient psychiatry clinic in order to clarify what usual care for anxiety disorders entails, and to determine the extent to which effective psychosocial treatment is accessible to, and implemented with anxiety disorder patients. Database queries generated from the billing and medical record system at the Los Angeles County Adult Outpatient Psychiatry Clinic identified 582 patients presenting with an anxiety disorder diagnosis in a 6-month time frame. These patients' electronic medical records were reviewed using a standardized data collection form. Findings indicated that the majority of patients received pharmacological treatment for their anxiety. The majority of the psychosocial treatment delivered was supportive therapy. Among the minority of patients who did initiate CBT, an even smaller minority received treatment that included an exposure component, and those who did receive exposure likely received a sub-optimal dose. Understanding usual care delivery patterns is an important preliminary step to identifying and addressing barriers to optimal anxiety disorder treatment in adult community mental health settings.
authors.affiliation: University of Southern California, Department of Psychiatry and the Behavioral Sciences, United States. Electronic address: kbtaylor@usc.edu.
authors.forename: Kate
authors.initials: K
authors.lastname: Wolitzky-Taylor
authors.affiliation: University of Southern California, Department of Psychiatry and the Behavioral Sciences, United States.
authors.forename: Martha
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: University of Colorado-Boulder, Department of Psychology, United States.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Arch
authors.affiliation: University of Southern California, Department of Psychiatry and the Behavioral Sciences, United States.
authors.forename: Earl
authors.initials: E
authors.lastname: De Guzman
authors.affiliation: University of Southern California, Department of Psychiatry and the Behavioral Sciences, United States.
authors.forename: Isabel
authors.initials: I
authors.lastname: Lagomasino
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003156:Community Mental Health Services; D019317:Evidence-Based Medicine; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D057240:Patient Preference / Q000523:psychology; D016896:Treatment Outcome
keywords: Anxiety disorders; Cognitive behavioral therapy; Community mental health; Exposure therapy; Implementation in usual care