Cognitive Behavioral Therapy Training Research Articles

Effect of psychological nursing intervention on anxiety level and quality of life in patients with gastrointestinal peptic ulcer.

Peptic ulcer is a common gastrointestinal disease, and psychological intervention has an important influence on its occurrence and development. To investigate the effect of psychological nursing intervention on the anxiety level and quality of life of patients with gastrointestinal peptic ulcers. Two groups of patients with peptic ulcer were selected from January to December 2012, with 60 cases in each group, and psychological nursing intervention and routine treatment were respectively performed. Psychological nursing interventions include cognitive behavioral therapy, psychological support and relaxation training. Self-rating anxiety scale (SAS) and quality of life questionnaire were used to evaluate the anxiety level and quality of life of patients before, during and after treatment. The SAS scores of the experimental group significantly decreased over the course of treatment, from 52.3 before treatment to 30.5 after treatment, while SAS scores of the control group did not change significantly. Meanwhile, the experimental group's quality of life score (SF-36) significantly improved over the course of treatment, from 65.2 to 85.2, while the control group remained stable. Further analysis showed that sex and age had no significant influence on the effect of psychotherapy. Both men and women, young and old, showed similar trends in anxiety relief and improved quality of life after treatment. Psychological nursing-based intervention program has a positive effect on the anxiety level and quality of life of patients with gastrointestinal peptic ulcer.

Trauma focused-cognitive behavioral therapy training effectiveness in promoting professional development of psychotherapists working with unaccompanied minors in Greece: a non-blinded randomized control trial.

The need to develop psychotherapists' skills to respond to current treatment challenges, such as addressing trauma due to the refugee crisis, is increasing. However, there is a dearth of evidencebased training for psychotherapists who work with refugees, especially in frontline countries. A randomly selected sample of 80 clinicians working with unaccompanied minors (UAMs) in Greek accommodation centers nationwide participated in an intensive trauma-focused cognitive behavioral therapy (TF-CBT) training (n=44) or a control-group (n=36) and completed the Professional Quality of Life Scale, the Work and Meaning Inventory and a questionnaire to assess knowledge and therapeutic skills, in pre-andpost measurements. Clinicians with 1-3 years of experience with refugees reported higher burnout (p=0.012, M=25.78 vs M=22.04) and secondary traumatic stress than those with less than a year (p=0.014, M=22.03 vs M=18.04). Positive meaning at work increased in both groups at post-test (TF-CBT group: p=0.019, M=15 vs M=13.6, and control group: p<0.001, M=15.17 vs M=13.42). The TF-CBT training group outperformed the control group in knowledge and skills (p=0.021, M=10.15 vs M=8.75) and identified a lower number of children with post-traumatic stress disorder symptoms (p=0.009, M=6.94 vs M=4.33) post-training. This study provides preliminary evidence on TF-CBT training effectiveness in equipping psychotherapists to work with UAMs, while their professional quality of life warrants further research.

Learning from therapists about the challenges and opportunities of training in cognitive behavioral therapy for psychosis: qualitative findings from a US-based service evaluation

ABSTRACT Background CBT for psychosis (CBTp) is a care standard for people with psychosis in the United States (US). However, CBTp access is poor. The context differs from the UK, where CBTp was primarily developed. This US-based service evaluation addresses a knowledge gap and forms a pilot study: a broad goal was to learn about CBTp training’s impact on therapists. Specific aims were to: 1) describe the challenges and opportunities of CBTp training by interviewing therapists competent in formulation-driven CBTp; 2) make recommendations for practice and research. Methods Therapists’ experiences of a 3-day CBTp workshop and 12-month consultation period in a US outpatient service were evaluated via focus groups. Participants were eight of ten therapists achieving CBTp competency. Results Thematic analysis of focus group content yielded four themes: 1) Before CBTp: Support and medication; 2) Hope and possibility; 3) A reality check; 4) The future: Ongoing development or “flavor of the week”. Discussion Therapist perspectives help elucidate barriers and facilitators for US CBTp implementation, from the challenge for therapist-case managers of accommodating CBTp, to the potential of shared therapeutic models for team cohesion. Recommendations include clarifying how best to use CBTp within large caseloads, and mixed method longitudinal studies of training.

The Role of Psychological Factors in Noncardiac Chest Pain of Esophageal Origin.

Noncardiac chest pain (NCCP) of esophageal origin is a challenging clinical problem of diverse etiology that affects more than 80 million Americans yearly. We assess the prevalence and impact of psychological disorders on NCCP of esophageal origin, describe possible mechanisms associated with this condition, and review psychological therapy options. Online search using PubMed and Medline from January 1, 1966, to April 30, 2023. Psychological disorders have been reported in up to 79% of patients with NCCP of esophageal origin. Several psychological disturbances have been identified with this condition, including depression, anxiety, panic disorder, phobias, and obsessive-compulsive and somatoform disorders. It is unclear whether the psychological disorders trigger the chest pain or vice versa. Multiple psychological mechanisms have been linked to chest pain and may contribute to its pathogenesis and severity. These mechanisms include cardiophobia, poor coping strategies, negative social problem solving, stress and perceived control, hypervigilance to cardiopulmonary sensations, altered pain perception, and alexithymia. Psychological therapies for NCCP of esophageal origin include cognitive behavioral therapy, hypnotherapy, physical and relaxation training, breathing retraining, and alternative medicine. Among the therapeutic options, cognitive behavioral therapy has been shown to be an effective treatment for NCCP of esophageal origin. This review raises awareness about the high prevalence of psychological disorders in NCCP of esophageal origin and highlights the need for clinical trials and trained therapists to address the management of this taxing clinical problem.

Effect of 8 weeks of cognitive behavioral therapy versus 8 weeks core stabilization training in the management of subjects with non-specific low back pain: a randomized controlled trial

BackgroundPatients with chronic pain usually regard pain as a stressful situation. The literature revealed that chronic pain is associated with social and cognitive dysfunction. Recently, the literature started to support using cognitive behavioral therapy to reduce the effect of chronic nonspecific low back pain.ObjectivesThe study aimed to assess the effect of cognitive behavioral therapy versus core stabilization training in the treatment of subjects with non-specific chronic low back pain.MethodsNinety subjects were enrolled in the current study, with mean age (32.30 ± 4.38) and mean weight (72.27 ± 10.88). They were equally randomized into three equal groups A, B, and C using opaque envelopes and computer-generalized numbers. Group A received cognitive behavioral therapy plus traditional treatment, group B received a core stabilization training program plus traditional treatment, and group C received only traditional treatment. Visual Analog Scale, Fear Avoidance and Belief Questionnaire, and Oswestry Disability Index were used pre- and post-treatment to measure the outcomes in response to the treatment plans.ResultsStatistical analysis revealed that there was a significant decrease in the Visual Analog Scale, Fear Avoidance and Belief Questionnaire, and Oswestry Disability Index post-treatment compared with pre-treatment in group A (P < 0.001), group B (P < 0.001), and group C (P < 0.001). Also, the results revealed that there was a significant decrease in the Visual Analog Scale, Fear Avoidance and Belief Questionnaire work/lifestyle, and Oswestry Disability Index of group A compared with group B (P < 0.05) and group C (P < 0.001) and a significant decrease in outcome measures in group B compared with group C (P < 0.05).ConclusionThe results of the current study support the involvement of cognitive therapy in the management of chronic pain as it guides the patient to be aware of the underlying mechanism of chronic pain and the management maneuvers to overcome such pain. Also, the results provide credit to cognitive behavioral therapy in terms of long-term relief of chronic pain.

Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta‐Analysis

ABSTRACTEffective training of mental health professionals is crucial for bridging the gap between research and practice when delivering cognitive behavioural therapy (CBT) and motivational interviewing (MI) within community settings. However, previous research has provided inconclusive evidence regarding the impact of training efforts. The current study aimed to systematically search, review and synthesize the literature on CBT and MI training to assess its effect on practitioner behavioural outcomes. Following prospective registration, a literature search was conducted for studies where mental health practitioners were exposed to training in face‐to‐face CBT or MI, reporting on at least one quantitative practitioner behavioural outcome. A total of 116 studies were eligible for the systematic review, and 20 studies were included in four meta‐analyses. The systematic review highlights the need to establish psychometrically valid outcome measures for practitioner behaviour. Results of the meta‐analyses suggest that training has a greater effect on practitioner behaviour change compared to receiving no training or reading a treatment manual. Training combined with consultation/supervision was found to be more effective than training alone, and no differences were found between face‐to‐face and online training. Results should be interpreted with caution due to methodological limitations in the primary studies, large heterogeneity, and small samples in the meta‐analyses. Future directions are discussed.

Effectiveness of Mentorship Using Cognitive Behavior Therapy to Reduce Burnout and Turnover among Nurses: Intervention Impact on Mentees.

Mentoring programs can improve nurses' mental health. This study examined the effects of a staff training program based on cognitive behavior therapy for burnout in which mentors provided intervention to their mentees. The principal investigator served as a facilitator and conducted staff training in cognitive behavior therapy. An original cognitive behavior therapy manual was presented to trained nurses (mentors), and lectures were provided on using the manual, ways of implementing cognitive behavior therapy, and other important points. The study participants included 35 mid-career nurses (mentors) and 34 young nurses in their first to third year (mentees) working in acute care hospitals. Groups of five mentees were formed in which two mentors provided cognitive behavior therapy based on the manual. Changes in mentees' stress, burnout, and turnover intention at pre-intervention, post-intervention, and follow-up (3 months after the intervention) were objectively evaluated using an evaluation index. The intervention significantly reduced the following evaluation indicators: total strain, conflict with other nursing staff, nursing role conflict, qualitative workload, quantitative workload, conflict with patients, problem avoidance due to irrational beliefs, escape-avoidance, emotional exhaustion of burnout, desire to change hospitals or departments, and turnover intention. Implementation of cognitive behavior therapy by mentors effectively reduced mentees' stress, burnout, and turnover.

Family-Based Treatment for Anxiety, Depression, and ADHD for a Parent and Child.

Children with mental illness commonly live with caregivers who suffer from mental illness. Integrated mental-health-treatment approaches can provide more convenient and comprehensive care for families. This case report describes family-based treatment (FBT) for one parent/child dyad. The parent was a 37-year-old female with a history of anxiety and major depressive disorder and concern for symptoms of attention-deficit/hyperactivity disorder (ADHD). The child was an 8-year-old female with generalized anxiety disorder and concern for ADHD and behavioral problems. The parent received individual cognitive behavioral therapy (CBT) and parent management training. The child received CBT. Both also received medication management. The FBT team met regularly for coordinated treatment planning. Self-reported assessments via the Child Behavior Checklist showed meaningful improvement; anxiety decreased to nonclinical range week 12 and depression decreased to nonclinical range week 8. Clinician assessments showed improvement for both patients. Though more time intensive, FBT can yield significant improvement, particularly for children. Pragmatic approaches to treatment planning are important to minimize barriers to FBT.

A Review of Behavioral and Pharmacological Treatments for Adult Trichotillomania

Trichotillomania (TTM) is a psychiatric disorder involving chronic, recurrent urges to pull out one’s own hair, arising frequently in childhood and early adolescence. This disorder predominantly affects women and has a high co-morbidity with many other psychiatric conditions. Currently, the etiology is unknown, which makes treating TTM extremely difficult. While the epidemiology and proposed causes will be discussed briefly, the primary purpose of this review is to provide a comprehensive, updated summary of the psychological and pharmacological management options for patients diagnosed with TTM, as new clinical trial data for previously studied and novel treatments have become available within the last decade. Of the behavioral interventions, cognitive behavioral therapy (CBT) and habit reversal training (HRT) have demonstrated the greatest improvements in hair-pulling severity, with HRT showing the most efficacy for long-term maintenance of progress. Pharmacological therapies with the most success include Olanzapine, Clomipramine, and N-Acetylcysteine, though larger replication studies are needed. Selective serotonin reuptake inhibitors (SSRIs) have yielded inconsistent results in clinical trials, yet they are frequently prescribed for TTM. Naltrexone, Dronabinol, and Inositol are emerging as potential treatments, but the results suggest that additional studies are needed. Future research directions include larger placebo-controlled pharmacological trials, exploring the efficacy of combined behavioral and pharmacological approaches compared to monotherapy, and delving into the potential genetic and neurochemical contributions that may underlie TTM.

EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial

IntroductionChronic back pain is a widespread medical condition associated with high socioeconomic costs and increasing prevalence. Despite the advanced implementation of multidisciplinary approaches, providing a satisfactory treatment offer for those affected is often not possible. Exposure therapy (EXP) promises to be an effective and economical form of treatment and in a previous pilot study showed to be superior to cognitive behavioral therapy (CBT) in reducing perceived limitations of movement. The current study aims to further compare the efficacy of both treatment methods and identify those patient groups that particularly benefit from EXP.MethodsThe general objective of this randomized multicenter clinical trial (targeted N = 380) is to improve and expand the range of treatments available to patients with chronic back pain. As the primary objective of the study, two different psychological treatments (EXP and CBT) will be compared. The primary outcome measure is a clinically significant improvement in pain-related impairment, measured by the QPBDS, from baseline to 6-month follow-up. Secondary outcome measures are absolute changes and clinically significant improvements in variables coping, psychological flexibility, depressiveness, catastrophizing, exercise avoidance and fear of exercise, and intensity of pain. Participants are recruited in five psychological and medical centers in Germany and receive ten sessions of manualized therapy by trained licensed CBT therapists or clinical psychologists, who are currently in their post-gradual CBT training. Potential predictors of each treatment’s efficacy will be explored with a focus on avoidance and coping behavior.ConclusionThis study will be the first RCT to compare CBT and EXP in chronic back pain in a large sample, including patients from different care structures due to psychological and medical recruitment centers. By identifying and exploring potential predictors of symptom improvement in each treatment group, this study will contribute to enable a more individualized assignment to treatment modalities and thus improves the care situation for chronic back pain and helps to create a customized treatment program for subgroups of pain patients. If our findings confirm EXP to be an efficacious and efficient treatment concept, it should gain more attention and be further disseminated.Trial registrationClinicalTrials.gov NCT05294081. Registered on 02 March 2022.

Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy.

To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.

Integrating "Super Skills for Exams" Programme in the School Curriculum to Support Adolescents Preparing for Their National Examinations in Turkey.

Examination stress is the most common stressor reported by adolescents across the globe. Exam stress involves mental distress related to anticipated academic challenges or fear of failure in the examinations, test anxiety, or fear of being unable to meet certain expectations of themselves or others. The aim of this study was to determine the effectiveness of a transdiagnostic resilience program (Super Skills for Exams; SSE), when integrated in the school curriculum and delivered by the school counsellors, in reducing exam stress among adolescents who are preparing for their national examinations. SSE is based on the principles of Cognitive Behaviour Therapy (CBT), behavioural activation, and social skills training, and includes sessions in promoting healthy lifestyles. Participants were 7129 (3661 female and 3468 male) adolescents in grades 7 and 8, from all the 245 secondary schools from Ugur College in seven regions and 31 cities across Turkey. All the participants completed a set of questionnaires to measure self-efficacy for learning and test anxiety, academic stress, emotion regulation, and lifestyles. Results revealed significant reduction in academic stress (i.e., test anxiety, work pressure, self-expectation, and despondency) and maladaptive emotion regulation strategies, and significant increase in self-efficacy and adaptive regulation strategies following the intervention. Adolescents who participated in SSE reported an increase in the consumption of healthy food. This study provides preliminary empirical support for the integration of SSE within the school curriculum for helping adolescents cope with exam stress as they prepare for their national exams.

Use of self-practice/self-reflection (SP/SR) exercises for competency-based training and assessment in CBT

Abstract With the increased demand for psychological services, and particularly for cognitive behavioural therapy (CBT), it is vital that teaching programs offer effective training that produce skilled and competent clinicians. This paper reviews the limitations of traditional approaches to training within the field of psychology, in terms of the promotion of a breadth of declarative knowledge at the expense of a deep and nuanced understanding of cognitive behavioural theory and clinical competence. It also reviews issues with existing strategies for competency-based assessment of trainees learning CBT. To date, many of these appear to assess a range of competencies concurrently and to test trainees within complex environments. Such methods may fail to provide an opportunity for the assessment of specific areas of competence and/or confound the assessment itself. It may also result in the public being exposed to trainees who are yet to develop competence. Based on recent research in training methods within psychology at large, and in relation to CBT specifically, a model of competency-based training and assessment is presented to address these issues. This model extends the existing research on the use of the experiential self-practice/self-reflection (SP/SR) framework for training in CBT. It proposes that the use of discrete exercises within a SP/SR training program promotes a more in-depth and nuanced appreciation of cognitive behavioural knowledge and skills and increased clinical competence. Furthermore, such exercises are proposed to provide an avenue for assessing clinical competence in specific skills prior to the commencement of direct client services. Key learning aims (1) To review literature on training for the development of clinical competence. (2) To review literature examining methods of assessing competence. (3) To propose the use of experiential training through a SP/SR framework as a method for providing both competency-based training and assessment.

Effectiveness of Cognitive Behavioral Therapy on Psychological Hardiness and Marital Relationship Quality in Couples with Marital Conflicts

Objective: The aim of the present study was to determine the effectiveness of cognitive-behavioral therapy on psychological hardiness and the quality of marital relationships in couples with marital conflicts. Methods and Materials: The research method was a quasi-experimental design with a pre-test and post-test with a control group. The statistical population of this study consisted of couples with marital conflicts in Tehran in 2023. Then, 32 couples with marital conflicts were selected through convenience sampling and randomly assigned to the experimental group (16 people) and the control group (16 people). The data collection tools were questionnaires on psychological hardiness and the quality of marital relationships. Subsequently, cognitive-behavioral therapy training was conducted on the experimental group over 8 sessions of 90 minutes each. After the training sessions, post-tests were administered to both the experimental and control groups. Findings: The findings indicated that the post-test scores of the experimental group in psychological hardiness and the quality of marital relationships were significantly better than those of the control group. Conclusion: Therefore, cognitive-behavioral therapy has an effect on psychological hardiness and the quality of marital relationships in couples with marital conflicts.

Contribution of socio-demographic and clinical characteristics to predict initial referrals to psychosocial interventions in patients with serious mental illness.

Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness. Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm. Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE. A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Cognitive Behavioral Therapy Training for Psychiatry Residents in Korea

Cognitive Behavioral Therapy Training for Psychiatry Residents in Korea

OPPORTUNITIES FOR PSYCHOLOGICAL ASSISTANCE TO GRIEVING FAMILIES AND CHILDREN

The article is devoted to an overview of the main targets and methods of individual and group psychological assistance to families and children in a situation of grief. Among the targets, there are targets directly related to grief, as well as related targets aimed at strengthening the stability of the family and updating additional resources for the healing of grief. The format of assistance can be not only individual, but also group. Among the effective methods, the possibilities of cognitive behavioural therapy, art therapy and self-regulation training are described. The effectiveness of group support programmes for children and adolescents is noted, which can become one of the promising areas of psychological assistance in modern conditions.

Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room.

The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth, presenting a major public health concern. Some studies have shown that cognitive behavioral therapy (CBT) has a positive effect on maternal psychology during delivery, reducing stress and shortening labor time. Thus, CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth. To investigate the clinical effects of CBT training and psychological care during delivery, and their therapeutic effects on women in labor. This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023. The study subjects were randomized into two groups: control (n = 70) and observation (n = 70). Routine care, CBT training, and psychological care were provided to mothers in both groups. Psychological status scores, delivery time, and satisfaction with care pre- and post-delivery were compared, and the incidence of complications after receiving care was analyzed between the two groups. Although the psychological state of both groups improved significantly in the late stages of labor, the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group (P < 0.05). The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group (P < 0.05). The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group (P < 0.05). CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression, shorten labor duration, reduce postnatal complications, and improve nursing satisfaction and nurse-patient relationships. Its clinical application is effective and has popularization value, providing a new way to protect maternal mental health.

Clinical Consultation During a Trauma-Focused Cognitive Behavioral Therapy Community-Based Learning Collaborative: Examination of Consultation Content, Consultative Strategies, and Provider Engagement

Consultation following evidence-based practice (EBP) training enhances the uptake of EBPs. Yet, little is known about what occurs during consultation, and it is often difficult for providers to engage in consultation. This study examined provider engagement in consultation and the content and strategies used during consultation following training in Trauma-focused Cognitive Behavioral Therapy (TF-CBT) as part of a community-based learning collaborative (CBLC). Minute-to-minute live coding of consultation calls revealed most content was clinically-oriented and the most common strategies used by consultants were didactic in nature. Providers with more years of professional experience and those with greater TF-CBT knowledge attended significantly more consultation calls. Providers with a greater average weekly caseload and providers who were supervisors presented significantly more cases on calls. Providers with greater TF-CBT knowledge spoke significantly more minutes on calls. Consistent with previous work, findings highlight difficulties with provider engagement in consultation and that providers with more baseline expertise are most likely to be engaged. Findings suggest tailoring EBP training efforts to better engage providers at greatest risk for low engagement.

Expanding Access to Cognitive Behavioral Therapy: A Purposeful and Effective Model for Integration

Integrated behavioral health (IBH) in primary care is growing as an approach to decrease barriers and provide earlier intervention for youth experiencing behavioral and mental health symptoms. However, increasing access to mental health providers alone without ensuring evidence-based treatment (EBT) is provided will not sufficiently address the current mental health crisis. To spread to scale, IBH needs to be implemented and tested in community-based practices with integrity to EBT. This paper provides a model for implementing cognitive behavioral therapy (CBT) in community pediatric primary care via master’s prepared therapists through an academic-community partnership. This paper describes the hiring practices, training in CBT, ongoing supervision and consultation, and use of data to inform the evolution of the model. Using a retrospective review of the rate of emergency department (ED) admissions per 1,000 patients with a diagnosis of depression, we compared practices enrolled in our academic-community partnership IBH model to practices who implemented their own IBH and practices with no IBH. Across a four-year period, we found that practices enrolled in the academic-community partnership IBH model had a lower number of patients per 1,000 patients with a diagnosis of depression admitted to the ED with behavioral health concerns compared to practices that did not incorporate an IBH therapist. There was no difference in ED admission rates per 1,000 between practices that hired their own IBH and those without IBH. Analysis of costs of the program against generated revenue from billed services demonstrated that the academic-community partnership model shows promise of sustainability.