Using cognitive behavioural therapy in practice: qualitative study of family physicians' experiences.

OBJECTIVE To investigate whether family physicians thought they could use cognitive behavioural therapy (CBT) in their practices, and if so, how, and to discover what the barriers to implementation might be. DESIGN Qualitative study using taped interviews. SETTING British Columbia and Ontario. PARTICIPANTS Physicians practising family medicine in a variety of settings who attended an educational session on CBT. METHOD Six months after participating in a 5-hour seminar on CBT, consenting physicians were interviewed to determine their experiences with using CBT in their practices. The interviews used a semistructured guide and were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used to identify key words and themes. MAIN FINDINGS Most participants (34 of 42) reported using elements of CBT in their practices. Barriers mentioned by physicians to offering CBT to patients were lack of time, practice distractions and interruptions, and the perception that some patients were not good candidates for CBT. Barriers to patients' accepting or using CBT were preferences for pharmacotherapy and lack of motivation or interest. Physicians could overcome some barriers by using CBT's structure; this reduced the amount of in-office time required and helped them cope with interruptions. They selected specific CBT methods that fit their practices and patients. CONCLUSION Most participants saw CBT as a useful part of practice and reported implementing it successfully. There were, however, barriers to implementation in primary care. These barriers need to be addressed if CBT is to be taught to primary care physicians and offered in their practices.