Understanding adherence to Cognitive Behavioral Therapy (CBT) in clinicians who treat eating disorders: A Self-Determination Theory approach



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Despite ample empirical support for Cognitive Behavioral Therapy in the treatment of eating disorders (CBT-ED), research indicates clinicians demonstrate poor adherence to CBT-ED. Several internal factors contribute to the lack of adherence, such as clinicians’ anxiety and negative attitudes towards ESTs. Deci and Ryan’s Self- Determination Theory (SDT) posits satisfaction of competency, autonomy, and relatedness is associated with increased motivation and reduced anxiety. Due to the notable lack of adherence to CBT-ED, the current study assessed the extent to which clinicians’ perceived competence, autonomy, and relatedness, along with their anxiety and attitudes towards ESTs are associated with adherence to specific core CBT-ED skills. Clinicians’ adherence to CBT-ED was measured through frequency (percentage of patients with whom they used each of 15 skills) and quality (the degree to which they used the skill). Factor analyses revealed 3 factors in Frequency of Adherence and Quality of Adherence: cognitive skills (FAcog/QAcog), behavioral skills (FAbx/QAbx), and collaborative skills (FAcollab/QAcollab). Clinicians also completed the Basic Psychological Needs Satisfaction at Work Scale to assess satisfaction of the three SDT factors, Intolerance of Uncertainty Scale – Short Form for clinicians’ anxiety, and Evidence-Based Practice Attitude Scale for clinicians’ attitudes to ESTs. The sample included 221 master’s level clinicians (n = 162) and licensed psychologists (n = 59) recruited online who self-identified as having treated >4 patients with EDs in the past year. After preliminary analyses, Model 3 in PROCESS for SPSS was used to conduct 12 moderated moderation analyses, with FAcog, FAbx, QAcog and QAbx as the outcome variables. Results indicated none of the 12 moderated moderation analyses revealed significant three-way interactions. However, anxiety was negatively associated with FAcog and FAbx, while competency and autonomy were positively associated with QAcog. Positive attitudes toward ESTs were associated with increased adherence in every model and successfully moderated the negative relation between anxiety and adherence, such that the association between anxiety and adherence weakened as attitudes toward ESTs became more positive. Consistent with previous research, the findings demonstrated strong associations between clinicians’ attitudes toward ESTs and adherence to CBT-ED. As such, addressing SDT factors in the workplace would not be as beneficial in increasing adherence to ESTs as targeting negative attitudes toward ESTs.



Psychology, Clinical