Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Abstract

Although there remains a significant amount to learn to guide researchers' mission of improving the availability and effectiveness of treatment for individuals with depression, this study demonstrates that an empirically supported treatment can be implemented in a community mental health center and may result in improved outcomes.

A Pilot Study Disseminating Cognitive Behavioral Therapy for Depression: Therapist Factors and Perceptions of Barriers to Implementation

“…Although there is research to suggest that training therapists in CBT results in improved client outcomes (Cukrowicz et al 2005;Simons et al 2010), CBT remains relatively unavailable to those in the community who need it most. The burgeoning field of dissemination and implementation science has developed in response to this science-practice gap.…”

Therapist Training in Empirically Supported Treatments: A Review of Evaluation Methods for Short- and Long-Term Outcomes

“…While other studies have not examined the statistical relationships between therapist adherence to protocol in practice settings and client outcomes, some studies report concurrent improvement in therapist adherence and improvement in client outcome Simons et al 2010). Similarly, in Miller et al (2004 comparison of training conditions, increased change talk was observed in clients treated by therapists who had received coaching and feedback during training; these therapists also demonstrated greater observer-rated adherence.…”

“…Observer-rated adherence and competence scales have been used to evaluate therapist performance in recorded therapy sessions in clinical effectiveness studies Martino et al 2008Martino et al , 2009Morgenstern et al 2001;Sheidow et al 2008;Simons et al 2010), and implementation studies (Liddle et al 2006; see also Schoenwald et al 2011). After workshop training, two studies (Miller and Mount 2001;Miller et al 2004) have asked therapists to mail session recordings from their own clinical practice for adherence and competence rating, and to participate in role-plays with standard-client actors immediately after workshop training.…”

“…Similarly, in Miller et al (2004 comparison of training conditions, increased change talk was observed in clients treated by therapists who had received coaching and feedback during training; these therapists also demonstrated greater observer-rated adherence. In a quasi-experimental study, experienced therapists were provided training in CBT for depression (Simons et al 2010). Taped sessions examined with the CTRS after training showed substantial improvements in use of CBT techniques, compared to sessions conducted by the same therapists before CBT training.…”

“…Inter-rater reliability is typically assessed by having some portion of tapes coded by two independent raters Liddle et al 2006;Martino et al 2008;Miller et al 2004;Morgenstern et al 2001;Sheidow et al 2008) or having all tapes coded by multiple raters and item scores averaged (Miller and Mount 2001) or agreed upon by consensus (Simons et al 2010). To enhance reliability, raters may rate a common tape for comparison to expert raters' scores; raters can then be provided with corrective feedback (e.g., Martino et al 2008).…”