Cognitive Behavioral Therapy Training Research Articles

How does supervision aid cognitive behaviour therapy skill development? Perspectives of CBT trainees: a thematic analysis

Abstract Eleven cognitive behaviour therapy (CBT) trainees in Scotland were interviewed regarding their experiences of clinical supervision and its impact on their skill development. Using thematic analysis, the authors developed four main themes: Linking Theory to Practice, Mirroring CBT in Supervision, The Expert Supervisor, and Trainees’ Reluctance to Give Negative Feedback. Clinical supervision was essential in helping trainees to link theory to practice; particularly through audio recordings, discussing formulations, and modelling and role-play. A CBT-specific approach to supervision and a CBT expert supervisor were also identified as valuable to learning. Trainees were reluctant to give negative feedback to supervisors, fearing negative consequences. The findings inform supervision practice. Key learning aims Readers of this paper will be able to: (1) Describe trainees’ most valued elements of CBT supervision. (2) Determine key learning methods in CBT supervision. (3) Explain the value of modality specific CBT supervision. (4) Articulate the context of supervision in CBT training and consider mutual feedback as a method to address identified challenges.

Cognitive Behavioral Therapy for Occupational Stress among the Intensive Care Unit Nurses.

Background and Aims:Nurses working in the intensive care units (ICU) are faced with numerous stressors that can pose a serious threat to their self-efficacy and affect the quality of care. The aim of this study was to evaluate the effectiveness of Cognitive Behavioral Therapy (CBT) on the ICU nurses’ occupational stress.Methods:This interventional study was conducted in a hospital in southeast of Iran. The participants included 120 nurses, who were randomly assigned into the control (n = 60) and intervention (n = 60) groups. In the pre-test, the occupational stress was assessed using Osipow questionnaire. Later, the intervention group attended the CBT course conducted in six 90 minute sessions. One month after the intervention, the post-test data were collected from both groups.Results:The means of occupational stress and its dimensions were not significant before the intervention between the intervention and control groups (P = 0.47). The means of occupational stress and its dimensions were moderately high at pretest for all nurses. In the post-test, the stress level and all its dimensions reduced from moderate-high to moderate-low (P < 0.001), except for the physical environment dimension that remained at the moderate-high level (P = 0.32).Conclusion:The findings showed that CBT was effective on the nursing stress. Therefore, CBT training is suggested in in-service training programs for nurses.

Cognitive Behavioral Therapy Training in Certified Public Psychologists

Cognitive Behavioral Therapy Training in Certified Public Psychologists

Pain management in bleeding disorders care: perspectives of Canadian Social Workers in Hemophilia Care

Abstract Background Pain associated with bleeding disorders has been demonstrated to have an impact on patients’ and families’ quality of life. Both acute and chronic pain are common experiences and require attention by professionals working in haemophilia treatment centres (HTCs). The benefits of psychological pain management strategies such as cognitive behaviour therapy and self-management skills training are well documented; however, it is not well understood how Canadian social workers involved in haemophilia care perceive and provide pain management support to patients. Aims To explore the current understanding of pain management and practice as well as the education needs of members of Canadian Social Workers in Hemophilia Care (CSWHC). Method Twelve semi-structured qualitative interviews were conducted with members of CSWHC. Transcribed interviews were coded with NVivo software and thematically analysed. Results The four key themes reflecting the experiences of social workers are: 1) Limited comprehension of key issues related to pain; 2) Conditioning to push through pain; 3) Expanding pain knowledge to enhance practice; 4) How we practice social work and choose to step in. Conclusion The current practice of CSWHC members aligns with literature in three main areas including assessment, instrumental services, and counselling. Social workers support the development of pain education and practical resources for patients with haemophilia who experience pain. While formal education, advocacy, and policy development of pain assessment and management are recognised, these areas require further research and development.

Validation of a Self-Assessment Scale for Therapists’ Perception of Cognitive Behavioural Therapy Skills in China: A Mixed Method

Cognitive behavioural therapy (CBT) is a first-line psychotherapy in Western countries, yet there have been limited studies examined the required skills based on perception of CBT therapists in the context of Western countries, and there has been no such research in China. Currently, there is no exist of a selfassessment scale to evaluate the required competence perceived by CBT therapists in China. This study used both qualitative and quantitative method to develop a self-assessment tool by CBT therapist to provide their perception about required skills in the treatment of mental disorders in China. Qualitative research used semistructured behavioural event interviews to identify the essential competences perceived by CBT therapists in China. Based on the qualitative research results, quantitative research was further used to develop a self-rated instrument with 52 questions. Three-hundred therapists who were conducting CBT therapy for clients with mental disorders were invited to participate in the study, 278 of which answered the survey. Among 25 therapists in the qualitative research, three key themes relating to the success of treatment using CBT were extracted from the interview. These themes including generic psychotherapy competencies, common CBT theory, mastering basic CBT techniques are essential skills in the effective application of CBT treatment. Another two themes on challenges and difficulties in the application of CBT include formulating clients’ problems and plans and using CBT techniques properly. Among 52 questions, 44 questions were analysed, which identified four CBT competence related factors: 1. generic psychotherapy competencies; 2. mastering CBT theory and skills; 3. using CBT techniques properly; 4. formulating clients’ problems and plans. The reliability using Cronbach’s α and half-reliability coefficient analysis showed that the therapist competence self-assessment scale had a high level of reliability of 0.94. The content validity, convergent validity and discriminant validity were high, and the structure of the instrument was reasonable. The self-assessment scale may provide a reliable and valid tool to self-assess the required competence and skills perceived by CBT therapists in China, and provide useful information for CBT training curriculum and program in China.

Experiential learning for trainee therapists through a shame attack exercise

Abstract Research on self-practice/self-reflection (SP/SR) programmes in training cognitive behavioural therapy (CBT) have shown promising outcomes over the past decade. To date, the SP/SR framework research has generally focused on entire programmes and has rarely assessed the utility of specific exercises as teaching tools. This study aimed to determine the utility of an exposure intervention known as a shame attack in helping to facilitate CBT training in a clinical psychology programe when delivered in a SP/SR framework. It also sought to examine the potential for the exercise to be used as a form of competency-based assessment. Forty-one student trainees engaged in self-directed shame attack exercises and provided written reflections on their experiences. The reflections were then studied via thematic analysis. The results indicate that the exercise provides an avenue for competency-based assessment of trainee therapists’ conceptual knowledge, formulation skills and intervention planning. It also promoted learning outcomes relating to a ‘deeper’ and more nuanced appreciation of CBT theory and practice. The shame attack exercise provided for personal development and the opportunity to experience typical client challenges with engaging in exposure interventions, which have the potential for enhancing empathy and cognitive behavioural skills. Key learning aims (1) To understand the usefulness of a shame attack exercise for training within a SP/SR framework. (2) To examine the potential for using SP/SR as a form of competency-based training. (3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.

Mental health in substance misuse patients in Wales

Purpose The purpose of this paper is to identify and report on the mental health needs of those attending substance misuse services (SMS) adhering to the diagnostic criteria as defined in DSM 5 with reference to common mental health disorders. It also examines differences in the numbers of appropriately trained cognitive behaviour therapy (CBT) therapists and highlights the lack of provision of CBT reflected in the much smaller number of accredited therapists in Wales compared to other parts of the UK. Design/methodology/approach This population was identified by way of an audit of data collected via the out-patient clinics conducted by the author. Findings The paper identifies a high proportion of patients who attended SMSs as having complex psychological need as a consequence of co-morbidity. Research limitations/implications The results of the audit may have limitations but the implications from the findings suggest potential value in looking more at clinical outcomes following evidence-based psychological interventions. Practical implications A conclusion from the findings is suggested value in a more structured approach to looking at clinical outcomes. Originality/value This audit was undertaken in North Wales. There is no IAPT or matrix-structured Level II CBT training programmes available in Wales. The audit identifies the need for more evidence-based psychological interventions such as CBT linked to the development of such services. The apparent lack of political will to change the status quo is also highlighted as a problem.

Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis

Irritable bowel syndrome (IBS) is a widespread chronic functional gastrointestinal (GI) disorder having bidirectional comorbidity with psychiatric disorders. This review focuses on psychological treatment of IBS, focusing on symptom severity rather than IBS diagnostic criteria. We chose this dimensional approach in order to assess mind-body effects as an alternative or complement to conventional medical treatment, which focuses on symptom relief. We calculated the effect sizes for various psychosocial-mind-body therapies (MBTs) for IBS symptoms in both children and adults. Therapies included meditation, relaxation, yoga, autogenic training, progressive relaxation, general training in stress coping, hypnotherapy, biofeedback, psycho-education, psychodynamic psychotherapy, and cognitive behavioral therapy. We performed a meta-regression analyses and mixed effects contrasts to find various outcome differences, and we analyzed their relative efficacy in both children and adults. We found 53 studies in 50 reports describing randomized controlled trials. Medium to high effect sizes were found across all methods compared with various controls, with possibly higher effects for children. We found no systematic differences among treatment methods. Meta-regression analyses showed no significant effect for the presence of psychophysiological training, meditation or explicit exposure procedures as treatment components, although most MBTs include exposure as a nonexplicit treatment characteristic, and many relaxation techniques have meditative characteristics. We conclude that there is considerable evidence that an array of mind-body and other psychological therapies can be effective complements to medical treatment for IBS symptom severity, with little evidence for relative superiority of any particular approach. We suggest that the various methods may operate through different mechanisms.

Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective.

Nonspecific chronic low back pain (CLBP) is a common clinical condition that has impacts at both the individual and societal level. Pain intensity is a primary outcome used in clinical practice to quantify the severity of CLBP and the efficacy of its treatment; however, pain is a subjective experience that is impacted by a multitude of factors. Moreover, differences in effect sizes for pain intensity are not observed between common conservative treatments, such as spinal manipulative therapy, cognitive behavioral therapy, acupuncture, and exercise training. As pain science evolves, the biopsychosocial model is gaining interest in its application for CLBP management. The aim of this article is to discuss our current scientific understanding of pain and present why additional factors should be considered in conservative CLBP management. In addition to pain intensity, we recommend that clinicians should consider assessing the multidimensional nature of CLBP by including physical (disability, muscular strength and endurance, performance in activities of daily living, and body composition), psychological (kinesiophobia, fear-avoidance, pain catastrophizing, pain self-efficacy, depression, anxiety, and sleep quality), social (social functioning and work absenteeism), and health-related quality-of-life measures, depending on what is deemed relevant for each individual. This review also provides practical recommendations to clinicians for the assessment of outcomes beyond pain intensity, including information on how large a change must be for it to be considered "real" in an individual patient. This information can guide treatment selection when working with an individual with CLBP.

One-Year follow-up effects of a cognitive behavior therapy-based transdiagnostic program for emotional problems in young children: A school-based cluster-randomized controlled trial

BackgroundThe present study examined the long-term efficacy of a transdiagnostic prevention program, Super Skills for Life (SSL), among young children with emotional problems. SSL is based on the principles of cognitive behavioral therapy, behavioral activation, and social skills training. MethodsOne-hundred and twenty-three Spanish-speaking children, aged 6 to 8 years, and their parents participated in the study. They were recruited from ten schools. Schools were randomly allocated to either the intervention (IG) or waiting-list control (WLC) groups. The children's parent completed a set of questionnaires to measure their child's anxiety and depressive symptoms, general difficulties and positive attributes, and psychosocial impairment. Parent's assessment at baseline and at a 12-month follow-up was assessed using an intent-to-treat approach. ResultsThe IG, compared to WLC group, showed significant baseline-to-follow-up reductions in anxiety and depressive symptoms, as well as in behavioral difficulties and psychosocial impairment in various life domains. LimitationsThe small sample size and the reliance on parental reports were the major limitations of this study. ConclusionsThis study provides initial evidence of the long-term effects of SSL, suggesting that it is a promising indicated preventive intervention for young children with emotional problems.

Effectiveness of a Short Education Series to Reduce Anxiety for Health Professions Graduate Students: A Pilot Study

Abstract. In college and graduate programs across the United States, educators have become aware that the psychological well-being of the current generation of students (often referred to as “Millennials”) needs to be an important area of focus. In 2007, 50.7% of American college students met the clinical criteria for a depressive or anxiety disorder. In the 2010 American College Health Survey, 48% of college and university respondents felt overwhelming anxiety at least once in the preceding year. These data make it clear that there is a need for effective interventions to help students reduce the emotional distress they experience. This pilot study examined the effects of an educational intervention on anxiety in graduate students. The intervention included cognitive behavioral therapy (CBT) and mindfulness training, in addition to education about lifestyle health behaviors and study habits. First year graduate students in the UT Southwestern School of Health Professions were recruited for the pilot study. The study design included 4 educational sessions to provide education/training in CBT, mindfulness, lifestyle, and study habits. Subjects completed outcome measures before and after the intervention including the Depression Anxiety Stress Scale-21 (DASS-21) and a survey about subjects' behaviors in the domains targeted in the study. Results indicated a decrease in student distress in DASS-21 overall and individual subtest scores. The results suggest that a comprehensive intervention was successful in impacting the depression, anxiety, and overall stress levels of the involved students.

To what extent are cognitive behaviour therapy competencies incorporated into clinical psychology training? A national survey of Australian universities

ObjectiveCognitive behaviour therapy (CBT) has demonstrated effectiveness as a therapeutic approach for various clinical disorders, but little data exist on the extent to which it is covered in accredited postgraduate clinical psychology training programs. Data were gathered regarding aspects of CBT orientation in terms of influence, content, delivery of general programs, and administration of coursework components.MethodResponses to a semi‐structured interview of 28 clinical program directors of Australian accredited courses (representing 72% of accredited courses) were analysed as part of a larger project titled “Nationwide Training in Cognitive Behaviour Therapy.”ResultsCBT was consistently included in training programs, but there was marked variability in the coverage of CBT competencies. Greater emphasis was placed on foundational CBT competencies (57% of programs indicating basic CBT skills were covered to a “large” or “very large extent”), in contrast to problem specific competencies (11% of programs covered to a “large” or “very large extent”). Programs with a stronger orientation towards evidence‐based practice reported greater coverage of Roth and Pilling's CBT competency framework (r = 0.62, p < 0.01).ConclusionThe findings suggest that core CBT skills are covered, but there is an opportunity for these clinical training programs to enhance their coursework content to ensure that their trainees are adequately prepared to deliver CBT for different disorders.

Implementing Mental Health Services for Children and Adolescents: Caregiver Involvement in School-Based Care.

This study compared clinician contact with clients' caregivers by service setting, specifically schools, which are the most common service setting for youths. Data were from a state-funded cognitive-behavioral therapy training initiative. Clinicians (N=177) completed pretraining and postconsultation surveys including retrospective reports of caregiver contact and amount of school-based practice. School-based clinicians were less likely than non-school-based clinicians to report any contact with caregivers. Full-time school-based clinicians were less likely than part-time school-based clinicians to report any contact with caregivers. School-based clinicians also were less likely than clinicians in other settings to have in-person contact with caregivers, and full-time school-based clinicians were less likely than part-time school-based clinicians to report in-person contact with caregivers. Given the inherent advantages of school-based treatment, integration of mental health services for youths in schools is increasingly supported by funding and policy. The findings of this study suggest, however, that investing in strategies to engage caregivers in such treatment may be worthwhile.

A COMPARISON OF TWO METHODS FOR REDUCING TEST-ANXIETY AND IMPROVING ACADEMIC PERFORMANCE

This study examined the effectiveness of cognitive behavioral therapy (CBT) and study skills training (SST) in reducing test-anxiety and improving academic performance. Eighty one high test-anxious male students in the tenth grade were randomly assigned to three groups: CBT, SST and waiting-list control (WLC). CBT aimed to help participants become aware of the anxiety-producing self-statements they emitted both before and during exams, and to train them to develop positive self-statements that would facilitate task attending; whereas SST aimed to teach participants the skills necessary for effective learning, namely SQ3R method of studying, techniques of time management, note-taking methods, test preparation techniques and test-taking techniques. All participants receiving treatment met for a total of six 50-minute treatment sessions spanning over six weeks. The data was analyzed using one-way ANOVA and one way MANOVA. The results indicated that both treatment groups made significant improvements from pretest to posttest in test-anxiety when compared to the WLC group. However, only the CBT group was superior to the WLC group in improving academic performance. Overall, the results were interpreted as giving support to the interference model of the debilitating effect of anxiety on performance.

Sexual Performance Anxiety.

Sexual performance anxiety (SPA) is one of the most prevalent sexual complaints; yet, no diagnosis is recognized for either gender. Thus, research into treatment has been minimal. Review the prevalence of SPA and its relation to sexual dysfunctions and anxiety disorders. Compare SPA to (non-sexual) performance anxiety and social anxiety (PA/SA). Apply pharmacologic principles to the known properties of drugs and phytotherapies to hypothesize treatments for SPA. Review SPA and PA/SA through PubMed searches for relevant literature from 2000 to2018. Prevalence was estimated using population-representative surveys. For treatment results, controlled clinical trial results were prioritized over open-label trial results. SPA affects 9-25% of men and contributes to premature ejaculation and psychogenic erectile dysfunction (ED). SPA affects 6-16% of women and severely inhibits sexual desire. Cognitive behavior therapy and mindfulness meditation training have been proven effective for PA/SA and are recommended for SPA, but controlled studies are lacking. Phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation, both of which include SPA as a major element. Drugs proven for PA/SA have adverse sexual and sedative effects, but serotonergic anxiolytics with prosexual effects (buspirone ± testosterone, trazodone ± bupropion) may have potential, and sage, passionflower, l-theanine, and bitter orange are anxiolytic. Nitric oxide boosters (l-citrulline, l-arginine, Panax ginseng) have the potential for increasing genital tumescence and lubrication, and plant-based alpha-adrenergic antagonists may aid sexual arousal (yohimbine/yohimbe, Citrus aurantium/p-synephrine). SPA causes or maintains most common sexual dysfunction. No treatments are well proven, although cognitive behavior therapy, mindfulness meditation training, and serotonergic anxiolytics (buspirone, trazodone, gepirone) have potential, and phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation. Several phytotherapies also appear to have potential. Pyke RE. Sexual Performance Anxiety. J Sex Med 2020;8:183-190.

"It's led me astray": How Cognitive Behavioural Therapists experience personal therapy in clinical practice

AbstractPersonal therapy is considered to be an essential component of most psychotherapeutic training programmes. However, it remains peripheral to cognitive behavioural therapy (CBT) training courses. We present a subsection of results from a qualitative study that examines how CBT therapists use personal therapy in their clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Participants were asked about how they used personal therapy in their clinical practice and their accounts were analysed using interpretative phenomenological analysis (IPA) to identify common themes. This article presents the results of the first master theme, “Personal therapy creates conflict”, which explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol‐led CBT. Results show that participants found personal therapy created considerable internal conflict, where their use of technical evidence‐based treatment protocols as practitioners was experienced in tension with the relationally oriented therapy they had received as clients. We discuss results in the context of Gabriel Marcel's philosophical insights on the dehumanising effects of technology on human relationships. We conclude with a brief consideration of the current political climate that increasingly privileges short‐term technical solutions to psychological distress.

Training and Clinical Impact of Cognitive Behaviour Therapy Workshops in a Teaching Hospital in North India.

Background:Cognitive behaviour therapy (CBT) is an empirically supported psychotherapy with applications across psychiatric disorders. The demand for nonpharmacological interventions is increasing in the developing world. Unfortunately, existing resources are unable to cater to treatment and training needs.Methods:The aim of the current paper is to provide a description of the format of a series of CBT training workshops and their clinical impact in a psychiatric tertiary care center in north India. Over a period of nine years, nine training workshops were conducted. CBT concepts and skills sets were inculcated in faculty and student participants, using teaching strategies based on adult learning techniques.Results:The workshops resulted in a tremendous increase in the number of patients taken up for CBT. While therapeutic and training outcomes were not systematically assessed, the naturalistic outcomes (60 out of 85 patients completed therapy; improvement reported by >90% of the completers) are encouraging and showcase capacity building by means of CBT training in these workshops.Conclusions:CBT training workshops are an effective way to impart CBT skills and, therefore, to build CBT expertise in a resource-poor setting.

Implementing evidence-based mental health practices in schools: Feasibility of a coaching strategy

PurposeMood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues.Design/methodology/approachIn this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students.FindingsIn total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group.Originality/valueThese findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT.

臨床心理士養成大学院におけるCBTトレーニングの基本構成要素と教育方法—日本のトレーニング・ガイドラインの策定に向けた実態調査—

The purpose of this study was to investigate the current status of the basic components and training methods of cognitive behavioral therapy (CBT) in Japan. The participants in this study were 74 university faculty specializing in CBT and affiliated with certified master's degree courses in clinical psychology graduate program training institutions in Japan. They were asked to complete a questionnaire regarding the components and methods of CBT training, and to provide a free description of educational components. The results indicated that the basic constituent elements of CBT were generally insufficiently covered. In particular, while basic education on CBT theory and techniques is relatively thorough, practical education and training seems to be lacking. In addition, the amount of instruction on these components varies widely among faculty members, showing a tendency for education to depend on the discretion of each faculty member. Finally, since it is thought that a number of constituent elements have become newly necessary for CBT training in the Japanese context, it is necessary to develop CBT training guidelines specific to Japan.

The Structure of Competence: Evaluating the Factor Structure of the Cognitive Therapy Rating Scale

The Cognitive Therapy Rating Scale (CTRS) is an observer-rated measure of cognitive behavioral therapy (CBT) treatment fidelity. Although widely used, the factor structure and psychometric properties of the CTRS are not well established. Evaluating the factorial validity of the CTRS may increase its utility for training and fidelity monitoring in clinical practice and research. The current study used multilevel exploratory factor analysis to examine the factor structure of the CTRS in a large sample of therapists (n = 413) and observations (n = 1,264) from community-based CBT training. Examination of model fit and factor loadings suggested that three within-therapist factors and one between-therapist factor provided adequate fit and the most parsimonious and interpretable factor structure. The three within-therapist factors included items related to (a) session structure, (b) CBT-specific skills and techniques, and (c) therapeutic relationship skills, although three items showed some evidence of cross-loading. All items showed moderate to high loadings on the single between-therapist factor. Results support continued use of the CTRS and suggest factors that may be a relevant focus for therapists, trainers, and researchers.