Cognitive Behavioral Therapy Research Articles

A scoping review: Cognitive Behavior Therapy (CBT) in self stigma for people living with HIV (PLHIV)

Background HIV is still a major global public health issue, despite the major progress in care and treatment. HIV-internalized stigma/self-stigma remains an important issue because it is unclear how many of the CBT interventions that have been developed have a specific focus on reducing the self-stigma associated with HIV. Methods This study used a scoping review that was conducted using PRISMA guidelines with databases from Cochrane, PMC, and ScienceDirect. Studies were eligible if published between 2013–2023, full-text, and using English. Results This study identified seven quantitative studies, one qualitative study, and two mixed-method studies. All the studies reveal the use of CBT as an intervention that helps to reduce self-stigma, improve mental health, and enhance medical adherence. Conclusion This systematic review explores the implementation of cognitive-based therapy (CBT) for facing self-stigma in people living with HIV, including the influence of m-health in the current situation as one of the innovative strategies to improve HIV patient’s well-being.

A Systematic Review of Parental Involvement in Digital Cognitive Behavioural Therapy Interventions for Child Anxiety

A Systematic Review of Parental Involvement in Digital Cognitive Behavioural Therapy Interventions for Child Anxiety

Smartphone-Based Cognitive Behavioral Therapy and Customized Sound Therapy for Tinnitus: A Randomized Controlled Trial.

To evaluate the efficacy of a smartphone-based application providing tinnitus-specific cognitive behavioral therapy and customized sound therapy for tinnitus. In a prospective randomized controlled trial, the treatment group participated in daily sound therapy and weekly interactive CBT modules, and the control group did not receive the program (waitlisted). Outcome measures after 8 weeks included the Tinnitus Functional Index (TFI), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Ninety-two patients (mean age = 57.2 ± 11.9 years) were included. The treatment (n = 47) and control (n = 45) cohorts had similar TFI, PHQ-9, GAD-7, PSS, and PSQI scores at presentation (all P > .05). Treatment-group patients had significantly higher improvements than controlled patients in their TFI (16.7 ± 14.9 vs 1.9 ± 10.8, P < .001), PHQ-9 (1.9 ± 4.2 vs -0.7 ± 3.4, P = .002), GAD-7 (1.1 ± 3.6 vs -0.9 ± 3.3, P = .009), and PSQI scores (2.5 ± 3.2 vs -1.1 ± 2.1, P < .001). Treatment-group subjects also significantly improved in 7 of the 8 TFI domains (all P < .05). TFI improvements of ≥20 occurred in 18 (38.3%) treatment subjects. Of the 9 treatment-group patients presenting with moderate-severe depression, 4 (44.4%) improved to minimal depression. Of the 4 treatment-group patients with moderate-severe anxiety, 2 (50.0%) improved to minimal anxiety. Of the 17 treatment-group patients with moderate-severe sleep difficulties, 10 (55.6%) had considerable sleep improvement. This novel smartphone application providing cognitive behavioral therapy and customized sound therapy was effective in reducing symptom severity and improving anxiety, sleep, and mood for tinnitus patients.

Experiences of undergoing internet-delivered cognitive behavioural therapy for climate change-related distress: a qualitative study.

Internet-delivered cognitive behavioural therapy (ICBT) has previously shown promise in effectively treating climate change-related distress. The aim of the present study was to investigate participants' experiences of undergoing a novel ICBT program targeting psychological symptoms associated with climate change. Telephone interviews were conducted with nine participants who had received eight weeks of ICBT for climate change-related distress. A semi-structured interview guide was used to gather information about participants' experiences of undergoing treatment. Data were transcribed and analyzed using thematic analysis. The thematic analysis resulted in three overarching themes: (1) Same old feelings, brand new strategies, (2) Bumps in the road, and (3) Personalized climate engagement. Participants experienced that they had developed new coping strategies for handling their emotions, encountered challenges during the treatment period, and adapted their pro-environmental behaviour to their individual needs and circumstances. The results indicate that participants were able to utilize the treatment material in different ways, resulting in a variety of emotional, cognitive, and behavioural changes. While the treatment was generally described as helpful, participants also raised some concerns regarding the treatment format. These findings can inform further development of ICBT targeting psychological symptoms associated with climate change.

The Impact of Cognitive Behavioral Therapy for Insomnia on Neurofilament Light and Phosphorylated Tau in Individuals with a Concussion.

Concussions damage neurologic tissue, increasing release of intercellular proteins including phosphorylated Tau (pTau) and neurofilament light (NfL). Disrupted sleep from a concussion negatively impacts the ability of the glymphatic system to remove cellular waste from the brain. The purpose of this study was to determine if enhancing sleep using Cognitive Behavioral Therapy for Insomnia (CBT-I) impacts pTau and NFL levels following a concussion. This is pre/post intervention analysis of a larger wait-list control study. Participants had their blood sampled pre/post the CBT-I intervention which was analyzed using SIMOA analytics. Paired sampling statistics and linear regression models were used to examine how insomnia severity impacts pTau181 and NfL. Twenty-eight participants were enrolled in this study. Age and baseline protein level were significantly associated with post-intervention protein levels, but post-intervention insomnia severity was not associated with post-intervention protein levels. About 50% of participants that had clinically meaningful change in insomnia and had a reduction in their NfL and pTau181 values. Post-intervention insomnia was not associated with post-intervention NfL or pTau. Yet, on an individual level, ~50% of participants had a clinically meaningful change in insomnia and reduced level of NfL and pTau 18.1. NCT04885205 https://clinicaltrials.gov.

Duration of insomnia and success expectancy predict treatment outcome of iCBT for insomnia

IntroductionIdentifying prognostic factors of treatment outcome may assist in customizing an intervention to a patient's needs. Hence, we conducted a secondary analysis of data from a randomized controlled trial to investigate the effectiveness of an internet-based cognitive behavioral therapy for insomnia (iCBT-I) to find patient characteristics that may predict the change of insomnia severity after treatment.Materials and methodsIn this exploratory analysis involving 94 chronic insomnia patients, we examined the predictive value of several self-reported measures, medical history, and sociodemographic variables to psychological distress with separate linear regression models. The main outcome was the Insomnia Severity Index score improvement from pre- to post-treatmentResultsThe study found that duration of insomnia, b (SE) = −0.02 (0.01), p = 0.01, and attitudes about the expected treatment success, b (SE) = 0.80 (0.27), p = 0.004, were predictors of a better outcome. Moreover, a better outcome was associated with a lower level of the following traits: attention seeking, b (SE) = −1.06 (0.51), p = 0.04; grandiosity, b (SE) = −1.50 (0.57), p = 0.01; distractibility, b (SE) = −1.57 (0.75), p = 0.04; and rigid perfectionism, b (SE) = −1.32 (0.65), p = 0.05.ConclusionOur results suggest that iCBT-I might be particularly beneficial for patients with higher expectations from the therapy and those who have a shorter duration of insomnia. Some pronounced personality traits, such as attention seeking, grandiosity, distractibility, and rigid perfectionism, may predict worse outcomes. However, because this was a post-hoc analysis, our results must be considered exploratory and verified in further studies.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT04300218?cond=NCT04300218&amp;amp;rank=1, Identifier NCT04300218.

Digital health intervention for children with ADHD to improve mental health intervention, patient experiences, and outcomes: a study protocol

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT).Methods/designWe will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period.DiscussionIndividuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes.This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024.

Examining Studies on the Effectiveness of Cognitive Behavioral Therapy in Treating Eating Disorders: A Look at Both Western and Asian Studies

This paper explores the effectiveness of cognitive behavioral therapy (CBT) in the treatment of eating disorders, looking at the findings of the past three years by examining Western and Asian studies. Eating disorders (EDs), as a global health problem, cover a range of serious mental health conditions marked by abnormal eating patterns, unhealthy food-related behaviors, and intense or obsessive obsession with weight and body shape. The purpose of this article is to discuss the effectiveness of cognitive behavioral therapy in the treatment of eating disorders. The article reviews the relevant Western and Asian studies and reviews a research result in the past three years. The result shows a more comprehensive assessment of clinical impairment, eating disorder symptoms, and anxiety symptoms in the context of the CBT-E intervention. However, there are limitations to the certainty of results in this literature due to differences between studies in design, follow-up period, sample size, and patient diagnosis and age. Future studies should further discuss the effects of treatment in different cultural contexts to more accurately understand the potential impact of treatment.

Implementing LGBTQ-affirmative cognitive-behavioral therapy: implementation strategies across five clinical trials.

LGBTQ-affirmative cognitive-behavioral therapy (CBT) is an evidence-based treatment for reducing transdiagnostic mental and behavioral health concerns among LGBTQ individuals. Preserving the effects of this intervention as it is translated into practice can maximize public health benefits. This study systematically identifies and evaluates implementation strategies for LGBTQ-affirmative CBT. First, we identified and operationalized implementation strategies used across five trials of LGBTQ-affirmative CBT using the Pragmatic Implementation Reporting Tool. Second, we evaluated the relative importance of these strategies via a quantitative assessment (N = 31 unique trial implementers). Survey responses were analyzed descriptively within each trial. Across all trials, we organized strategies as (1) high priority, (2) moderate priority, and (3) optional (if resources are available) for implementing LGBTQ-affirmative CBT. Within each trial, we identified 20 or more implementation strategies that were used, many of which overlapped across trials. We identified nine high priority strategies (e.g., working with clients to engage them in LGBTQ-affirmative CBT), nine moderate priority strategies (e.g., conducting ongoing training in LGBTQ-affirmative CBT), and nine optional/resource dependent strategies (e.g., showing visual indicators of LGBTQ affirmation within the physical spaces where LGBTQ-affirmative CBT is delivered). LGBTQ-affirmative CBT is a complex intervention requiring a package of implementation strategies. Our findings provide guidance for implementers in settings with different levels of resources regarding the highest priority strategies that may be needed to preserve the effectiveness of LGBTQ-affirmative CBT as it is translated into real-world settings.

Neuroscientific Approaches to Understanding Adolescent Susceptibility to Substance Abuse

Adolescence is a pivotal developmental stage characterised by significant neurobiological changes that heighten susceptibility to substance abuse. This period is marked by the maturation of the brain regions responsible for decision-making and impulse control, alongside an increased sensitivity to rewards driven by dopaminergic pathways. This review aimed to understand adolescent susceptibility to substance abuse using a neuroscientific approach. In line with best practices, data were collected from a variety reliable source to ensure a comprehensive view of the topic. Research studies on adolescent neurodevelopment have contributed to a broader understanding of the physiological and psychological factors at play during adolescence, while grey literature, including expert interviews and focused group discussions, has offered practical insights from frontline professionals, such as psychologists, social workers, and healthcare providers, who deal directly with adolescent substance use. These results demonstrate that the relationship between genetic factors and environmental conditions, such as stress and trauma, intensifies this vulnerability, thereby heightening the likelihood of individuals participating in risky behaviours. This review examines the neuroscientific foundations of substance use during adolescence, highlighting the critical role of timely interventions that utilize neuroplasticity to enhance resilience and reduce risk. By integrating cognitive training and behavioural therapies into public health initiatives, adolescents' cognitive control mechanisms and their propensity for substance abuse can be reduced.

Effectiveness of a multi-component sleep-mood group intervention on improving insomnia in university students - a pilot randomized controlled trial.

Sleep and mental health problems are very common in university students. The objective of this study was to assess the effectiveness of a multi-component sleep-mood intervention on improving sleep and mental health in university students with clinically significant insomnia symptoms, and to investigate possible mediators. Thirty-five participants were randomized to the Sleep Mood Intervention: Live Effectively (SMILE) intervention (n = 23), or wait-list group (n = 12). SMILE is a multi-component group therapy and includes elements of cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and lifestyle modifications, in four weekly two-hour sessions. The primary outcome was insomnia severity. Secondary outcomes were severity of depression and anxiety, and quality of life (QoL). Dysfunctional beliefs and attitudes about sleep and pre-sleep arousal were assessed as mediators. Intention-to-treat analysis showed significant time x treatment interaction on insomnia symptoms p = .02, partial η²=0.15, d = 0.84 [95% CI: 0.63 to 1.14], with significantly lower insomnia severity for SMILE compared to waitlist at post-test. No significant effects were found on depression d = 0.02 [95% CI: -0.35 to 0.37], anxiety d = 0.15 [95% CI: -0.16 to 0.53], and QoL d = 0.09 [95% CI: -0.25 to 0.42]. Dysfunctional beliefs mediated the effect on insomnia severity, but pre-sleep arousal did not. This integrated group intervention is associated with reductions in insomnia symptoms in university students. Since no significant effects were detected on mood and QoL, future studies with larger sample size may explore the effects of this intervention on these outcomes. Registry: Overzicht van Medisch-wetenschappelijk Onderzoek. NL-OMON46359. Date of registration: September 18th, 2018.

Understanding the Effectiveness of Cognitive Behavioural Therapy: A Study on Offenders

Background Cognitive behavioural therapy (CBT) is well known for its effectiveness in addressing psychiatric disorders such as depression, anxiety, PTSD, and borderline personality disorder, often used alongside medication. Summary CBT is used more often in the criminal justice system to help rehabilitate offenders by targeting cognitive distortions affecting their social and decision-making abilities. These maladaptive behaviours and sense of entitlement can result from distortions, which CBT works to address by restructuring thought patterns and encouraging adaptive behaviours. In general, CBT is a crucial method for decreasing repeat offences and dealing with mental health problems within the legal system. Key message CBT has demonstrated encouraging outcomes in decreasing reoffending rates in both youths and adults, aiding criminals in acquiring abilities to successfully re-enter society. Although it has replaced traditional rehabilitative services such as education and occupational therapy, its success highlights its importance in offender rehabilitation programmes. Nevertheless, inmates are frequently required to participate, causing doubts about their willingness to engage voluntarily.

Evidence-Base Update of Psychosocial and Combination Treatments for Child and Adolescent Depression

ABSTRACT Objective This evidence-based update (EBU) builds on three previous reviews (1998, 2008, 2017) sponsored by the Society of Clinical Child and Adolescent Psychology with the aim of evaluating the empirical support for psychosocial interventions for depression in youth. Method In the current review period (2014–2022), 25 randomized controlled trials (RCT) were identified: four in children and 21 in adolescents. Descriptive effect sizes and number-needed-to-treat (NNT) ratios were calculated for primary outcomes. Results were integrated with prior reviews, and cumulative evidence used to classify treatments as well-established, probably efficacious, possibly efficacious, or experimental. Published secondary analyses of predictors, moderators, and mediators were examined. Results For adolescents, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT-A), CBT in combination with antidepressant medication, and collaborative care programs were all classified as well-established. The evidence was considerably weaker for children, with no treatments achieving well-established or probably efficacious status. New developments include greater exploration of parent- and family-mediated treatment models and increasing evidence on technology-assisted interventions. Data on predictors, moderators, and mediators continued to be focused on adolescent depression samples and drawn from a limited number of RCT datasets. Conclusion Since the prior EBU, there has been incremental progress in youth depression treatment research. There is an urgent need to: (a) develop innovative approaches to substantially improve on the modest effects seen in most RCTs, (b) expand the evidence base for children and other underserved groups, (c) craft evidence-based guidelines for choosing between interventions when multiple efficacious treatments do exist, and (d) address issues of treatment effectiveness and scalability to ameliorate the wide prevalence and high impact of depression in youth.

E-Health Interventions for Managing Spine Pain—Benefits for Pain, Quality of Life, Catastrophizing and Fear Avoidance Beliefs: An Overview of Systematic Reviews With Meta-Analysis

OBJECTIVE: To summarize the effectiveness of eHealth interventions for improving pain, physical disability, psychological factors, and the quality of life for people with spine pain. DESIGN: Overview of systematic reviews. LITERATURE SEARCH: CINAHL, Embase, PubMed, and SPORTDiscus e-databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analysis of randomized clinical trials evaluating any type of eHealth were included. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of included reviews. The degree of overlap between reviews was calculated. RESULTS: Sixteen systematic reviews were included. Of them, thirteen reviews were exclusively focused on back pain or low back pain. Exercise and psychological interventions were the primary contents of eHealth interventions. In general, eHealth interventions based on physical exercise may improve the quality of life of people with low back pain. eHealth interventions based on cognitive behavioral therapy may reduce pain catastrophizing and fear-avoidance beliefs for physical activity for people with low back pain. eHealth interventions based on multidisciplinary approaches including physical exercise may reduce low back pain. Few systematic reviews used the GRADE system to evaluate the certainty of evidence, and few specified the content of eHealth interventions. CONCLUSION: eHealth interventions may improve the quality of life, pain catastrophizing, fear-avoidance beliefs, for people with low back pain. It is unclear, based on available systematic reviews, how clinicians should deliver eHealth interventions for people with spine pain (e.g., neck pain or low back pain).

PSYCHOLOGICAL DISORDERS IN BURN PATIENTS: A META-ANALYSIS OF DISORDERS AND TREATMENTS

The main subject of this paper is the psychological disorders experienced by burn patients, with a particular emphasis on the necessity of psychological intervention in their treatment. The research seeks to investigate prevalent mental health conditions, including post-traumatic stress disorder, depression, and anxiety, and assess the efficacy of various therapeutic approaches.The method relied on a comprehensive review of prior literature and a thorough evaluation of the outcomes from relevant studies. The findings indicated that a significant portion of burn victims experience various psychological disorders. This includes post-traumatic stress disorder (PTSD), depression impacting, and anxiety affecting. The research also highlighted the significance of providing psychosocial support to enhance treatment results, as well as the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR), Cognitive-Behavioral Therapy (CBT) and Virtual Reality (VR) techniques in addressing these conditions.To ensure comprehensive and effective patient care, it is recommended to integrate psychological interventions into burn treatment protocols, as stated in the paper's conclusion.

Can Project-Based Learning with Cognitive Behavioural Therapy Enhance Attitudes Towards Science?

Can Project-Based Learning with Cognitive Behavioural Therapy Enhance Attitudes Towards Science?

Changes in insomnia and binge-eating symptom severity before and after treatment of eating disorders in individuals with non-low-weight binge-spectrum disorders.

Although emerging research suggests insomnia is a significant problem among people with eating disorders, little is known about how insomnia symptoms may serve as risk factors for eating disorder symptoms, treatment outcome, and relapse. University students with non-low-weight eating disorders (N = 89) completed a mobile guided self-help cognitive behavioural intervention for eating disorders. Insomnia and binge-eating symptoms were assessed at pre-treatment and end-of-treatment using the Insomnia Severity Index and Eating Pathology Symptoms Inventory. Multiply imputed datasets were used to test associations between insomnia and binge eating before, during and after treatment. Insomnia was positively associated with binge-eating symptoms prior to treatment (r = 0.47). Baseline insomnia symptoms were associated with binge-eating symptoms at end-of-treatment (est = 0.269). Eating disorder treatment modestly reduced insomnia (d = -0.38); however, about half of people with clinically significant insomnia prior to treatment remained symptomatic. Insomnia symptoms and binge-eating symptoms did not change concurrently during treatment. Overall, results support an association between insomnia and binge eating. Although eating disorder treatment may impact insomnia, many individuals remained symptomatic for sleep problems, suggesting the need for follow-up treatments, such as cognitive behavioural therapy for insomnia, or the development of integrated insomnia-eating disorder treatments. Future studies are needed to examine causal links between insomnia and eating disorder symptoms, and test if insomnia predicts relapse after eating disorder treatment.

Treating the Psychological Distress in Children with Adventitious Blindness

Less than half of those who need mental health counseling receive it globally, underscoring the urgent need for psychology-focused intervention. According to data, 30.9% of Nigerians experience psychological anguish. This study investigated the efficacy and moderators of group cognitive behaviour therapy in psychologically distressed schoolchildren with adventitious blindness in Nigeria. A total of 98 students with adventitious blindness were recruited and participated in this study. The participants were assessed at three points using Perceived Emotional Distress Inventory. A mixed model ANCOVA with repeated measures shows that the CBT treatment had a dependable significant effect in decreasing psychological distress. The results showed that sociodemographic factors do not significantly moderate the efficacy of CBT treatment on the reduction of psychological distress in schoolchildren with adventitious blindness. In conclusion, the effect of a group cognitive behavioural therapy had a consistent significant reduction in psychological distress and none of their sociodemographic characteristics moderated the effects. Therefore, cognitive-behavioural practitioners should collaborate with special schools to diagnose and provide CBT treatment to schoolchildren living with adventitious blindness.

Cognitive behavioral therapy combined with selective serotonin reuptake inhibitors for premature ejaculation: A systematic review and meta-analysis.

Premature ejaculation (PE) remains one of the most common male disorders. Many clinical trials have shown that cognitive behavioral therapy (CBT) has significant efficacy in the treatment of PE. The purpose of this article is to review the current evidence regarding the efficacy and safety of CBT combined with selective serotonin reuptake inhibitors (SSRIs) for treating PE. We selected eligible randomized controlled trials (RCTs) from databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang, VIP, China Biology Medicine (CBM), Pubmed, Embase, and Cochrane Library. All data in this paper were analyzed using STATA 17.1 software. Cochrane Evaluator's Manual 5.3 was used to assess the quality of the included literature. Data collection was conducted up until May 2024. Finally, 15 high-quality randomized controlled trials were included, with 1243 patients, 653 experimental groups and 590 control groups. The meta-analysis showed that, compared with SSRIs alone, behavioral therapy combined with SSRIs can significantly prolong the IELT of PE patients, and improve perceived control over ejaculation, Chinese Index of Premature ejaculation-5 (CIPE-5), sexual life satisfaction, and spouses' sexual life satisfaction. Furthermore, there were no significant differences in side effects between the two groups. In addition, the published bias test results showed no significant bias. CBT combined with SSRIs could be a viable alternative for the treatment of PE. Both cognitive and behavioral training or behavioral training alone as a supplement to SSRIs are effective, with no significant increase in adverse reactions.

Should We Use Clinician Self-Report to Tailor Implementation Strategies? Predicting Use of Youth CBT with Clinician Self-Report Versus Direct Observation.

Developing tailored implementation strategies to increase the use of evidence-based practice (EBP) requires accurate identification of predictors of their use. However, known difficulties with measuring EBP use complicates interpretation of the extant literature. In this proof-of-concept study, we examined whether the same predictors of use of cognitive behavioral therapy (CBT) are identified when CBT use is measured with clinician self-report compared to direct observation. We examined four candidate predictors of CBT use - clinician participation in an EBP training initiative, years of experience, caseload, and employment status - in a sample of 36 clinicians (64% female; 72% White and 28% Black) from 19 community mental health agencies treating youth in greater Philadelphia. CBT use was captured for 100 unique client sessions (M = 2.8 recorded sessions per clinician) through both clinician self-report and direct observation, using parallel measures. We used three-level (client, clinician, and agency) regression models with random intercepts to estimate the relationship between each predictor variable and CBT use in both measures and compared the magnitude and direction of each model across self-report and direct observation using z-tests. There was no alignment for any of the four candidate predictors between predictive relationships identified by self-report compared to those identified by direct observation. The findings in this study extend literature documenting limitations of using clinician self-report to capture clinician behavior and suggest that even the characteristics that predict higher self-reported CBT use do not align with (and often are discordant with) those that predict directly observed CBT use. This raises questions about the utility of relying on self-reported use to inform implementation strategy design.