Thematic framework analysis of patients’ experience regarding gCBT for generalised anxiety disorder

Abstract

Compared to other anxiety disorders, treatment outcome is thought to be poorer for individuals diagnosed with generalised anxiety disorder (GAD). To improve treatment outcome, it is important to understand why symptom improvement takes place. One approach is to study what change mechanisms patient’s experience as helpful or unhelpful. Cognitive flexibility is an important change mechanism in cognitive behavioural therapy (CBT). Therefore, the aim of this study was to understand what therapy components are experienced as helpful and if cognitive flexibility is identified as a being a change mechanism in a newly developed group-based CBT (gCBT) for GAD.This study was a cross-sectional, thematic framework analysis. A sample of 4 participants were interviewed using a semi-structured interview, all diagnosed with GAD and received the gCBT. They were asked open-and closed ended questions regarding what was helpful or unhelpful in treatment, what they believed to have influenced symptom change and how their symptoms changed. The interviews were transcribed verbatim, after which themes were identified based on a seven-step thematic framework analysis guide. The analysis revealed three overarching themes, six sub-themes and fifteen sub-subthemes. The overarching themes were; therapy components, cognitive flexibility and treatment outcome. All participants experienced the components of the gCBT to be more helpful rather than unhelpful and all reported increased cognitive flexibility, which was consistent with Salkovskis theory regarding cognitive flexibility as being an important mechanism of change in CBT. The results imply that a further need is for extensive research on mechanisms of change to improve treatment options for individuals with GAD.Keywords: Generalised anxiety disorder, gCBT, cognitive flexibility, mechanisms of change, thematic framework analysis.