The Gap Between Evidence and Practice: Why Anxiety Treatment Often Falls Short

In a revealing study published in the journal Behavior Modification, researchers Dr. Brett J. Deacon and Leilani J. Hipol from the University of Wyoming uncovered concerning patterns in how mental health professionals treat anxiety disorders. Their findings highlight a significant disconnect between what science tells us works best and what therapists actually provide in real-world settings.

What the Study Examined

The researchers surveyed 51 licensed psychotherapists in Wyoming from various mental health professions about the techniques they used to treat clients with anxiety disorders in the past 12 months, including:

• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Panic Disorder
• Social Phobia (Social Anxiety Disorder)

Key Findings: A Troubling Gap

The study revealed several noteworthy findings about anxiety treatment in real-world practice:

Most Therapists Claim to Use CBT, But Few Use Its Most Effective Component

Nearly all therapists (98%) reported using Cognitive-Behavioral Therapy (CBT) for anxiety disorders. However, when examining specific techniques, a troubling pattern emerged:

• Therapist-assisted exposure therapy—considered the gold standard and most powerful component of evidence-based anxiety treatment—was rarely used (19-33% across disorders)
• Less effective but more comfortable CBT techniques were widely used, including:
  • Cognitive restructuring (>90%)
  • Progressive muscle relaxation (70-80%)
  • Breathing retraining (70-76%)
  • Mindfulness techniques (73-80%)

Non-Evidence Based Techniques Are Frequently Used

The study also found that many therapists combine evidence-based techniques with approaches that lack strong scientific support:

• Non-directive supportive psychotherapy (used by >70% of therapists)
• Psychodynamic therapy (used by about 50%)
• Pseudoscientific approaches like Thought Field Therapy (19-28%)
• Art therapy (17-28%)

Self-Identified “Anxiety Specialists” Often Use Less Evidence-Based Approaches

Perhaps most concerning, therapists who advertised themselves as anxiety specialists were actually:

• Less likely to use therapist-assisted exposure therapy than non-specialists
• Significantly more likely to use pseudoscientific techniques like Thought Field Therapy

What This Means For People Seeking Anxiety Treatment

These findings have important implications for anyone seeking help for anxiety disorders:

The Label “CBT” May Not Mean What You Think

When a therapist says they provide “CBT for anxiety,” this could mean almost anything—from highly effective exposure-based treatment to a hodgepodge of techniques with questionable compatibility. The researchers suggest that a better question to ask potential therapists might be: “What kind of CBT do you provide?”

Evidence-Based Treatment Is Hard to Find

Even in 2013 when this study was published, decades after exposure therapy was established as the most effective treatment for anxiety disorders, most therapists weren’t providing it. This suggests that simply finding a licensed mental health professional doesn’t guarantee you’ll receive the most effective treatment.

Knowledge Is Power

Understanding what constitutes effective anxiety treatment can help you make better decisions about your mental health care:

1. Know the gold standard: Exposure therapy is the most effective treatment component for most anxiety disorders. For example:
   • OCD: Exposure and response prevention
   • PTSD: Prolonged exposure therapy
   • Panic disorder: Interoceptive exposure
   • Social anxiety: Gradual exposure to feared social situations
2. Ask specific questions: When seeking treatment, ask potential therapists if they provide therapist-assisted exposure therapy, not just whether they offer CBT.
3. Be wary of practitioners who use many different techniques: The study found that most therapists use a large number of techniques from different theoretical orientations, which may dilute treatment effectiveness.
4. Consider self-directed exposure: If therapist-assisted exposure isn’t available, client self-directed exposure (used by 49-70% of therapists) can still be beneficial with proper guidance.

Moving Forward

This research by Dr. Deacon and Hipol highlights the challenges in disseminating evidence-based practices to community settings, particularly in rural areas. The good news is that most therapists expressed interest in receiving additional training in CBT for anxiety disorders.

For those seeking help with anxiety, this study serves as an important reminder that not all therapy is created equal. Taking an active role in understanding evidence-based treatments and asking the right questions can help ensure you receive the most effective care possible.

This article summarizes research from: Hipol, L. J., & Deacon, B. J. (2013). Dissemination of Evidence-Based Practices for Anxiety Disorders in Wyoming: A Survey of Practicing Psychotherapists. Behavior Modification, 37(2), 170-188.