Patient acceptability of group transdiagnostic cognitive behavior therapy for the treatment of anxiety disorders in community-based care: a qualitative study

Abstract

ABSTRACT Objective Cognitive-behaviour therapy (CBT) is a research-supported treatment for anxiety disorders. Transdiagnostic CBT protocols have been recently developed to manage multiple anxiety disorders. The efficacy of transdiagnostic CBT is directly dependent on acceptability as perceived by patients and health care providers. In this study, we sought to examine the acceptability of transdiagnostic CBT from the patient perspective within the context of a community-based group delivery for mixed anxiety disorders. Method An embedded qualitative study was conducted as part of a pragmatic randomized clinical trial of group transdiagnostic CBT for anxiety disorders. Semi-structured interviews were conducted based on a meta-framework of the concept of acceptability. Acceptability of the therapy was examined with a thematic analysis of interview verbatims. Results Seventeen patients were interviewed. Patients’ perception of acceptability of tCBT was classified into eight themes: 1) therapy features; 2) intervention components; 3) group format; 4) group cohesiveness; 5) co-therapists with different expertise; 6) quality of therapeutic alliance; 7) perceived effectiveness; and 8) access to the therapy. Conclusion The acceptability of transdiagnostic group CBT for patients was generally perceived as adequate in community-based therapy. Recommendations to enhance acceptability of the group therapy were related to group size, group dynamics and exposure. KEY POINTS What is already known about this topic (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Studies generally report good acceptability for CBT, but dropout rates suggest a potential area for improvement. (3) To date, few studies have examined the comprehensive concept of acceptability of CBT from the patients’ perspective. What this paper adds (1) A qualitative study was conducted with a meta-framework of the concept of acceptability in the context of a community-based therapy. (2) The acceptability of transdiagnostic group CBT for patients was generally perceived as adequate. (3) Recommendations to enhance acceptability emerged from participants’ experiences concerning the topics of group size, group dynamics and exposure.