Therapists’ Access to Care Rates and the Effectiveness of Anxiety Treatment

Wednesday, February 1

Anxiety disorders are widespread health conditions. The prevalence of these disorders in Western countries is estimated at approximately 10% (Baxter et al., 2013). Furthermore, these rates have also exacerbated throughout the COVID-19 pandemic, with an approximate 25% increase (WHO, 2022). Anxiety disorders comprise a broad range of conditions that, while differentiated by distinct etiologies, share the core symptoms of persistent worry and/or anxiety. The natural course of these disorders is also similar, as they are characterized by chronic progression. If left untreated, these disorders rarely display spontaneous remission or recovery (Carpenter et al., 2018; McAleavey et al., 2019). Prompt access to care is paramount to successfully treating mental health conditions (WHO, 2022). Unfortunately, provider shortages too often cause treatment-seeking individuals to wait for treatment for extended periods of time, with deleterious effects on their lives and well-being (e.g., Akutsu et al., 2004; Bell & Newns, 2004; Festinger  et al., 2002; Gallucci et al., 2005; Hoffman  et al., 2011; Kruse & Rohland, 2002; Paige & Mansell, 2013; Reitzel et al., 2006). Previous research on access to care has shown that longer wait times prior to first sessions were associated with higher rates of psychotherapy dropout (Bugatti et al., 2023; Reitzel et al., 2006; Swift et al., 2012). However, there is less research on therapists’ average access to care practices. 

It is commonly known that therapists differ in their effectiveness (see Wampold & Owen, 2021 for review). On average, therapists account for 5-10% of the variance in therapy outcomes (Baldwin & Imel, 2013; Barkham et al., 2018; Wampold & Imel, 2015). Despite the well-documented presence of therapist effects in psychotherapy, little is known about the specific therapist characteristics and practices that underpin these differences. While there is limited empirical evidence that some static therapist factors predict outcome (e.g., age, gender, degree type; Wampold & Owen, 2021), there is a paucity of studies examining non-static factors (e.g., caseload, availability, time to first session) impacting client outcomes.

In a study of 2,826 clients and 613 therapists we examined how therapists’ average time to first session (i.e., access to care) was related to their clients’ anxiety outcomes via the GAD-7. Via multilevel analyses, we found therapists’ average time from case assignment to first session across their caseload predicted outcomes (p < .05), with longer wait times associated with poorer outcomes. Since this effect was significant at the therapist, but not at the client level, it appears that therapists who generally take longer, on average, to meet with their clients for their first session produce worse outcomes regardless of the wait time experienced by each individual client. Though speculative, several therapist characteristics and skills might be considered when attempting to explain this finding. It is plausible that therapists who are less responsive from an organizational and administrative perspective might display a similar behavioral pattern within the clinical context. Indeed, therapist effects have been seen to generalize across domains of effective practices (see Kraus et al., 2015; Wampold & Owen, 2021). Alternatively, therapists practicing in multiple settings might struggle to manage their caseload. Future studies should further investigate this line of research, which has rarely, if ever, been previously explored. 

Clinical Implications: 

  1. It is imperative for therapist to routinely track their response time (i.e., average wait time from first contact to first session). This could identify areas of growth in their practices. 
  2. Inform prospective clients about up to date, expected wait times, which could be reported by therapists on their websites and other online profiles. 
  3. If therapists are unable to meet with new clients within a short period of time (within a week or so) therapists should refer to clinics or therapists with better availability. 
  4. To aid the scheduling process, the use of automatic online scheduling platforms is advised, since this can avoid the need for multiple emails or phone calls.

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