(PS3-82) Reasons for Discontinuing Group Cognitive Behavioral Therapy for Anxiety and Anxiety-related Disorders: A Thematic Analysis

Rationale: To increase, enhance, and expedite community access to psychological care, clinics often employ group cognitive behavioral therapy (CBT) as a resource-efficient treatment modality. A meta-analysis by Swift & Greenberg (2012) revealed that 20% of patients prematurely discontinue otherwise effective psychotherapeutic treatments, diminishing the overall efficacy of treatment and reducing the benefits of treatment to the community. Little is known about treatment discontinuation from the patient perspective (i.e., their treatment experiences and self-reported discontinuation reasons). It is critical to investigate factors contributing to premature discontinuation of group CBT from the patient perspective in order to maximize group CBT’s benefits in our communities.

Purpose: We aimed to investigate the reasons behind patients’ premature discontinuation of group CBT for anxiety and anxiety-related disorders at an outpatient clinic.

Methods: Patients who discontinued group CBT for anxiety and/or anxiety-related disorders at a specialty outpatient clinic in Ontario, Canada were invited to participate in an online survey, which included the Early Discontinuation of Group Therapy Questionnaire (EDGT; ATRC, 2019). An open-ended query in this questionnaire asked patients to express what factors contributed to their decision to discontinue treatment. A total of 37 participants across multiple disorder-specific CBT groups responded to this question, and their responses were analyzed using thematic analysis. The initial analysis yielded five common themes, which were subsequently refined to six themes after two rounds of coding by the first author, consultation with the clinic team, and input from the clinic’s clinical director––an expert clinician and researcher.

Results: The following six major themes emerged, with the percentages indicating the proportion of the sample reporting an issue within each thematic category: discomfort with group format and/or group dynamics (40.5%), lack of relevance to specific issues/needs (29.7%), issues with CBT content, pace, structure, and/or length (27%), issues with treatment facilitators and/or organization (27%), interference of previous therapy experience (13.5%), and issues with virtual format (10.8%). Inter-rater agreement for coding responses within these thematic categories was relatively strong (r = 0.79, p < 0.01).

Conclusion: The current study addresses an understudied yet critical research question. The findings provide insight into areas of improvement for clinics delivering group CBT, such as efforts to increase treatment group cohesion, enhance the relevance of treatment content to patients’ specific needs, and improve treatment organization and facilitation (e.g., reduce waitlist times and stay on topic during sessions). One limitation to note is response bias as not all patients who discontinued treatment responded to the survey. It is imperative for clinics to prioritize seeking feedback from patients who prematurely discontinue treatment and to proactively address preventable causes. This approach can lead to increased treatment success, increased treatment engagement, and reduced barriers to group CBT within our communities.