Investigating Service Users’ and Therapists’ Beliefs and Attitudes Regarding Evidence-Based Practice and Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is a widely used psychotherapy. CBT has a large evidence base indicating its effectiveness for a range of psychological difficulties. However, research has indicated that CBT is frequently not offered to service users who might benefit from it. Furthermore, CBT that is offered is often of poor quality, with therapists failing to use evidence-based techniques. It has been suggested that research into therapists’ beliefs about Evidence-Based Practice (EBP) and CBT might provide insight into the under-provision of high-quality CBT. Additionally, research into service users’ beliefs about CBT could provide insight into whether these beliefs are similar or different to therapists’ beliefs. The similarity of service users’ and therapists’ beliefs has implications as to whether service users’ preferences for therapy are understood and acknowledged by therapists. This thesis aimed to contribute to research in this area by investigating service users’ and therapists’ beliefs and attitudes regarding EBP and CBT. The first part of the thesis reports a systematic literature review and meta-analyses. These explored the link between therapists’ beliefs and attitudes regarding EBP and therapists’ usage of EBP CBT. Nineteen studies were included within the systematic review and seven studies were included within each of two meta-analyses. Results indicated associations between therapists’ attitudes or beliefs towards EBP and therapists’ use of EBP CBT in most studies. Effect sizes varied from small to large, although the majority were small. Associations were found for both positive and negative attitudes and beliefs. Associations were found for attitudes towards EBP overall, as well as beliefs regarding specific EBP CBT techniques. Meta-analyses found a significant association between therapist openness to EBP and EBP CBT use, but not between intuitive appeal of EBP and EBP CBT use. The second part of the thesis reports a quantitative research study. This study explored the beliefs of therapists and service users on the importance of alliance and adherence to techniques across three stages of CBT. Therapists were also asked to predict service users’ beliefs regarding alliance and adherence importance. Results indicated that therapists view adherence and alliance as more important than service users do, with the largest discrepancy found over alliance in early therapy. Therapists were also found to accurately predict service users’ beliefs about the alliance. However, therapists underestimated the importance of adherence to service users. Personal characteristics and experiences of CBT were found to be associated with therapists’ and service users’ beliefs, respectively. Taken together, both parts of the thesis suggest that therapists’ beliefs about EBP and CBT can impact their delivery of CBT. Furthermore, therapists might hold different beliefs about CBT than service users. Therapists might also make incorrect assumptions regarding the nature of service users’ beliefs about therapy. These differences in beliefs and incorrect assumptions could have important clinical implications, as therapists’ beliefs might be influencing them to deliver therapy that is incongruent with service users’ preferences.