Barriers to evidence-based psychotherapy implementation: An international survey of workload, training, and clinical
Naoki Takamatsu1, Ekachaeryanti Zain2,3, Ka Ying Heidi Lo4
1Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan.
Aim:
To examine the implementation of evidence-based psychotherapy across international healthcare contexts and identify barriers to clinical delivery.
Methods:
We conducted an international, cross-sectional, web-based survey of psychiatrists from October 2024 to March 2025. The questionnaire assessed familiarity with 10 evidence-based psychotherapy modalities, frequency of use, delivery confidence, perceived barriers, and clinical workload. Responses from 16 countries were analyzed across five geographic regions using chi-squared tests and effect sizes.
Results:
Among 424 respondents, 201 (47.4%) demonstrated low composite familiarity with evidence-based psychotherapies. Cognitive behavior therapy maintained moderate familiarity across regions, while other modalities remained largely unfamiliar. Japan exhibited the most constrained practice environment, with 48.3% reporting consultations under 10 min compared to 15.1% in other regions, and 30.0% seeing 40 or more patients daily. Major time constraints were reported by 63.3% of Japanese psychiatrists, significantly higher than other regions (P = 0.015). Frequent use of evidence-based psychotherapy was lowest in Japan (20.0%) and highest in the Middle East (60.0%). Despite these challenges, 77.4% of all respondents rated these approaches as highly important. Respondents identified improved postgraduate training (54.0%), continuing education access (38.2%), and enhanced supervision (36.0%) as priorities.
Conclusion:
Implementation varies across healthcare contexts, with Japan exemplifying system-level constraints where brief consultations and high patient volumes override practitioner knowledge and motivation. While psychiatrists value evidence-based approaches and seek to implement them, organizational barriers ultimately determine actual practice patterns. Findings indicate that training initiatives without concurrent structural reforms cannot bridge implementation gaps. Effective integration requires alignment of education, healthcare delivery structures, and payment systems.
Clinical Trial Registration:
Not applicable.
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