Wanted: Reliable and valid measures for the science of cognitive behavioral therapy dissemination and implementation.

Abstract

The dissemination and implementation of cognitive behavioral therapy (CBT) is stalled by the lack of empirical data to guide the content and evaluation of training programs. To address the questions of "What should be taught?" and "What do clinicians learn?" reliable and valid measures of therapist behaviors and practice elements are needed. The objective of this report is to identify existing CBT measures and to assess their ability to address these critical questions. We conducted a comprehensive literature review to identify measures of CBT declarative and procedural knowledge. We identified two measures of therapist declarative knowledge, one measure of client declarative knowledge, 22 measures of therapist procedural knowledge, and four measures of client procedural knowledge. Domain coverage, psychometrics, correlations among measures, and relationship to clinical outcomes varied considerably. Measures were evaluated in terms of whether, and to what degree, they might help address key CBT dissemination and implementation questions. Although some of the current set of CBT measures are well suited to the purposes for which they were originally developed, they do not provide the needed technology for advancing CBT dissemination and implementation. Recommendations for measure development are offered.

A model and guide for evaluating supervision outcomes in cognitive–behavioral therapy-focused training programs.

“…As such, the procedure of using evidence-based rating systems to objectively code therapy sessions will remain the gold standard, at least until the discrepancy between raters is better understood. Simons et al (2013) identified several measures that assess clinician fidelity broadly. However, it should be noted that a combination of measures and procedures are likely necessary to carefully assess these three components of fidelity.…”

“…Simons et al (2013) describe commonly endorsed urban myths about CBT, for instance, that it is too rigid, does not honor the therapeutic relationship, and does not focus on the role of emotions. For many clinicians, CBT does not appear to align with their core attitudes and values.…”

Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis)

“…On the other hand, some studies found no significant relationships between therapist competence and outcome in the treatment of anxiety disorders (e.g., Boswell et al, 2013;Huppert et al, 2001). However, inappropriate methodological approaches, like the evaluation of therapist competence with only one global item might be responsible for the heterogeneous findings in research (Simons et al, 2013;Webb et al, 2010;Weck et al, 2011a). There is no consistent evidence which supports that therapist adherence impacts therapy outcome (Baldwin and Imel, 2013;Webb et al, 2010).…”

Using Measurement-Based Care to Enhance Any Treatment

“…Unfortunately, research suggests that clinicians may not use full-package, complex EBPs due to the burden associated with training, negative attitudes toward manuals or protocols, and beliefs that these EBPs may not be appropriate for clients in the settings in which they practice (e.g., Simons, Rozek, & Serrano, 2013). Moreover, research indicates that even if initially implemented with success, these complex EBPs are not likely to be sustained over time (Stirman et al, 2012).…”