Does training in CBT improve outcomes?
Since CBT has a good track record in treating a range of problems, it would seem to go without saying that training therapists in CBT would improve outcomes. There is quite a bit of evidence that therapists who are practicing CBT produce good outcomes in real-life community settings. However, there actually hasn't been much research that looks directly at whether training community therapists in CBT makes a difference in the effectiveness of the treatment they provide.
A recent study (Simons, et al, 2010) examines the effects of training community therapists in CBT by comparing the performance of 12 community therapists who received CBT training (a two-day workshop followed by a year of group telephone consultation) with their performance before they received the training. After receiving the training, the therapists performed better on the Cognitive Therapy Rating Scale and their clients showed significantly greater improvement in both depression and anxiety. In other words, training in CBT worked and resulted in significant improvements in outcome. This is good news for those of us who provide training in CBT. For more on training in CBT see: Big push to train British therapists in CBT, How do I find good training in CBT?, Would your Agency, Hospital, or Organization like to offer training in CBT? and Scholarships for CBT Training at Beck Institute. Simons, A. D., et al, (2010).Training and dissemination of Cognitive Behavior Therapy for depression in adults: A preliminary examination of therapist competence and client outcomes. Journal of Consulting and Clinical Psychology, 78, 751-756. |
Re: Does training in CBT improve outcomes?
A similar study conducted in a different type of setting can be found at http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract
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Re: Does training in CBT improve outcomes?
Simply providing training may not be enough to get therapists to actually provide evidence-based treatment in practice. Practical and administrative barriers can interfere. A recent study examined ways of facilitating the adoption of CBT in clinical practice:
Michael R Kauth, Greer Sullivan, Dean Blevins, Jeffrey A Cully, Reid D Landes, Qayyim Said, Thomas A Teasdale, 2010. Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study, Implementation Science 2010, 5:75. I believe it can be accessed online, free of charge at: http://www.implementationscience.com...-5908-5-75.pdf |
Improving the Quality of training in CBT
Some mental health professionals receive their training in CBT in grad school. This is a good thing if the training includes both coursework in CBT and a practicum where students are supervised by an experienced clinician as they practice CBT with an assortment of clients. Taking a course or two and a practicum many not give the student in-depth training, but at least one has a chance to learn the basics of CBT. In theory, one then can get more training and experience in an internship, post-doctoral fellowship, or on-the-job training in one's first job. However, unless one specifically seeks out training in CBT, it can be hard to find and, with the budget cut-backs that many agencies have faced, it is increasingly difficult for new practitioners to find supervisors who are knowledgeable in CBT and who have the time available to provide clinical supervision.
Since not every grad school makes even a basic level of training available and not every grad student takes advantage of the opportunities that are available, many mental health professionals end up getting their training in CBT through continuing education (CE) programs and/or through independent reading. Unfortunately, many CE programs are not designed and implemented in a way that is likely to do a good job of equipping participants with the knowledge and skills needed for one to practice CBT skillfully. In particular, the traditional one-day workshop is not an effective format for learning to practice CBT. In December, 2009 the Institute of Medicine published a report (available at http://www.iom.edu/Reports/2009/Redesigning-Continuing-Education-in-the-Health-Professions.aspx) that concludes that there are major flaws in the way CE in the healthcare professions is conducted, financed, regulated, and evaluated. Their solution is to propose establishing a public-private institute to improve the nation's system of continuing education. Unfortunately, that "solution" sounds as though it means spending a lot of time and money erecting a bureaucracy, holding committee meetings, and conducting research before anything is actually done to improve the quality of CE programs. A public-private institute may actually be a good idea, but there are a number of things that can be done now to improve CE programs. In 2007 the National Center for Educational Research published a report "Organizing Instruction and Study to Improve Student Learning: A Practice Guide" which is available at http://ncer.ed.gov. The report is focused on educating students at the elementary through high-school level but almost all the points they cover apply to post-grad-school training as well. Here are some ideas taken from that report that you can make use of whether you are attending a CE program, presenting a CE program, or hiring someone to provide CE (the part in bold is taken from the report, the rest is my idea):
Think of the CE programs that you've attended... How many of these ideas did they incorporate? If you've attended any of my workshops in the past, I probably only incorporated a few of them. Now I incorporate significantly more of them and I'm going to incorporate as many as possible into the Distance Education program that we're pilot-testing. It isn't hard, it requires a little thought. CE presenters, you can increase the effectiveness of your programs with a little thought and planning. CE attendees, vote with your pocketbooks - pay attention to these points when deciding which programs to register for. |
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