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Unread October 13th, 2010, 11:00 AM
James Pretzer James Pretzer is offline
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Default 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.
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Unread October 18th, 2010, 07:54 PM
James Pretzer James Pretzer is offline
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Default Re: Does training in CBT improve outcomes?

A similar study conducted in a different type of setting can be found at
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Unread October 19th, 2010, 03:02 PM
James Pretzer James Pretzer is offline
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Default 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:
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Unread December 16th, 2010, 04:56 PM
James Pretzer James Pretzer is offline
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Default 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 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 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):
  1. Space learning over time. A one-day workshop will be much less effective than a program that presents the same material over time. If you are attending a one-day workshop, read up on the topic beforehand, attend the workshop, try putting what you've learned into practice, find colleagues to discuss your experiences with, do more reading, and attend other workshops on the same topic. If you're presenting CE, try to present programs that extend over time rather than one-time programs. At the very least, be sure to encourage participants to do additional reading and provide some way for participants to ask follow-up questions. If you're hiring someone to provide CE, have them provide an extended program, not a one-time program.
  2. Interleave worked example solutions with problem-solving exercises. If you're attending a CE program and they don't do this, ask yourself "How would that apply with ________?" rather than just listening passively to the presenter. If you're presenting CE, don't just present case examples that are completely solved, sometimes present the first part of the case example then ask participants to brainstorm about what to do next before telling them what you think. Ask them to apply what you've covered.
  3. Combine graphics with verbal descriptions. If you're attending a CE program where they don't do this, draw your own diagrams, charts, etc. If you're presenting a CE program, present the material verbally, as written text, and via diagrams, charts, etc. Presenting the material through more than one modality improves recall. If you're hiring someone to provide CE, find out how they plan to present the material... Do they use readings to complement their presentation? Do they use slides and handouts to summarize and supplement their presentation?
  4. Connect and integrate abstract and concrete representations of concepts. If you're attending a CE program and they don't do this, ask yourself what the important principles are and identify concrete examples of those principles. If you're presenting a CE program, make a point of clearly stating the principles behind the topic you're discussing, present concrete examples, and discuss how the example reflects the principles. If you're hiring someone to present CE, you may need to ask for a sample presentation in order to know if the presenter does this.
  5. Use quizzing to promote learning. If you're attending a CE program where they don't do this, before the presentation ask yourself what questions you want to be able to answer after the program is done, at the end quiz yourself on the points that were covered, later review your notes and quiz yourself again. If you're presenting a CE program, begin by raising questions that the program will answer, provide a quiz (with correct answers) that participants can use to assess their mastery of the material covered. If you're hiring someone to provide CE, ask them to do this.
  6. Help students allocate study time efficiently. If you're attending a CE program where they don't do this, before the program review what you already know about the topic and highlight the area where you are weakest. If you are presenting a CE program, help participants assess their understanding of the topic and identify ways in which they can increase their understanding of the areas where they are weak (the quizzes discussed above can be useful in doing this). If you are hiring someone to provide CE, ask the presenter how they will do this.
  7. Ask deep questions in order to build explanations If you're attending a CE program where they don't do this, find a colleague who is also attending and ask each other challenging questions that require deeper thought. If you're presenting a CE program, ask deep questions and allow time for participants to respond (if it is a large audience, you may need to use rhetorical questions). If you are hiring someone to provide CE, ask the presenter how they will do this.

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.

Last edited by James Pretzer; December 17th, 2010 at 05:35 PM.
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