Grand Rounds, March 6, 2018
University of Manitoba, Rady Faculty of Health Sciences, Department of Psychiatry.
Presented by Dr. Jitender Sareen, Dr. Tanya Sala and Ms. Tara Brousseau-Snider.
Feasibility of Large Group Cognitive Behavioural Therapy Education Classes for Anxiety Disorders
Joshua Palay, Jacquelyne Y Wong, Jason R Randall, Tanya Sala, James M Bolton, Patricia Furer, Shay-Lee Bolton, Debbie L Whitney, Vishal Thakur, Sagar V Parikh, Jitender Sareen
Rationale, aims and objectives
Cognitive behavioural therapy (CBT) is effective in treating anxiety disorders. In publically funded systems, CBT is not easily accessible due to long wait times. In order to provide quicker access, a large group CBT intervention was implemented in a tertiary care clinic. This study describes the design, feasibility and acceptability of such an intervention as part of stepped care for anxiety disorders.
The intervention followed a 2-session curriculum, consisting of 90 minutes classes providing didactic instruction on key CBT topics and self-management strategies. Classes accommodated 30 patients and were led by staff psychiatrists formally trained in CBT. A retrospective analysis of patients referred to the clinic during the first year of class implementation was performed to determine class completion rate, patient satisfaction (using a usefulness Likert Scale and Session Rating Scale [SRS]) and symptom trajectory (using the GAD-7).
The implementation of large group CBT classes reduced waiting times from approximately one year to approximately 3 months. One hundred and thirty-one patients were screened by the clinic, 88 of whom (67%) completed the intervention. Sixty-eight percent of patients rated the classes as useful; however, SRS findings indicated that only 46% of patients were satisfied. GAD-7 scores decreased by 1.57 (95% CI 0.2 to 2.95; SMD=0.24).
This analysis contributes preliminary evidence that large group CBT education classes may be an acceptable means to reduce waiting times for CBT for anxiety disorders. Further controlled research is required to elucidate the benefit and cost effectiveness of such classes.
Keywords: Anxiety disorders, cognitive behavioural therapy, cost effectiveness, evaluation, health services research, patient expectations, patient satisfaction, person-centered healthcare, self-management, waiting times