Cognitive Behavioural Therapy Competence Research Articles

Development of competence in cognitive behavioural therapy and the role of metacognition among clinical psychology and psychotherapy students.

There is a paucity of research on therapist competence development following extensive training in cognitive behavioural therapy (CBT). In addition, metacognitive ability (the knowledge and regulation of one's cognitive processes) has been associated with learning in various domains but its role in learning CBT is unknown. To investigate to what extent psychology and psychotherapy students acquired competence in CBT following extensive training, and the role of metacognition. CBT competence and metacognitive activity were assessed in 73 psychology and psychotherapy students before and after 1.5 years of CBT training, using role-plays with a standardised patient. Using linear mixed modelling, we found large improvements of CBT competence from pre- to post-assessment. At post-assessment, 72% performed above the competence threshold (36 points on the Cognitive Therapy Scale-Revised). Higher competence was correlated with lower accuracy in self-assessment, a measure of metacognitive ability. The more competent therapists tended to under-estimate their performance, while less competent therapists made more accurate self-assessments. Metacognitive activity did not predict CBT competence development. Participant characteristics (e.g. age, clinical experience) did not moderate competence development. Competence improved over time and most students performed over the threshold post-assessment. The more competent therapists tended to under-rate their competence. In contrast to what has been found in other learning domains, metacognitive ability was not associated with competence development in our study. Hence, metacognition and competence may be unrelated in CBT or perhaps other methods are required to measure metacognition.

A study of self-perceived change in CBT competence among Norwegian therapists undertaking a 2-year CBT training for working with young people

Abstract The rising prevalence of mental illness among youth has underscored the critical need for proficient therapists trained in effective methods for treating prevalent mental disorders. As mental health services grapple with resource constraints, the demand for shorter training programs has increased. This study aimed to investigate whether therapist competence improves continuously over a two-year cognitive behavioural therapy (CBT) training course, whether specific CBT skills show greater improvement than generic skills, and whether self-perceived competence varies based on therapist characteristics. Data were gathered from seven different CBT training courses spanning the years 2013–2021 involving a total of 151 Norwegian therapists. Therapist self-assessed their CBT competence using the Cognitive Therapy and Adherence Scale (CTACS). The collected data were analysed using mixed effects models using the R program. The findings revealed a significant increase in self-reported competence throughout the two-year training period. Notably, skills related to case formulation and CBT techniques displayed the most substantial improvements, indicating a high level of competence attained by the conclusion of training. No significant interactions were identified between time and therapist characteristics. The outcomes of this study support the efficacy of in-depth training through an extended CBT course spanning multiple semesters. The observed progress in CBT skills suggests that investments in therapist training can yield high levels of competence. Furthermore, this investment appears warranted regardless of therapists’ individual characteristics. Key learning aims (1) To gain insight into the differential development of generic and CBT specific competence during CBT training. (2) To reflect on the significance of therapist characteristics in the training process. (3) To reflect on the possible importance of reaching a high level of CBT competence during CBT training.

Psychometric properties of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) in a Turkish sample.

Cognitive behavioural therapy (CBT) training is highly demanded by clinicians; however, a standardized competence assessment for professionals working with children and young people (CYP) can be problematic. Psychometric tools used for this purpose are typically adult oriented measures. The present study provides psychometric properties of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) derived from a comparative analysis with the Cognitive Therapy Scale (CTS). The CBTS-CYP was used alongside CTS in a CBT supervision training course, consisting of a cohort of 51 therapists. A total of 36 audio/video recorded full CBT sessions were assessed for the purpose of determining CBT competence and adherence to the theory and model. The training involved a total of 80 hours of supervision in 10 meetings via an online videoconferencing platform between July 2020 and February 2021. Face validity and inter-rater reliability of CBTS-CYP were high, with the intraclass correlation values being good (0.60-0.74) or excellent (0.74 and above); the correlations of each CBTS-CYP and CTS items were significant; internal consistency of the scale showed that Cronbach alpha values for total-scale and its two subdimensions were above .93. For a cut-off score of 55 out of 90, sensitivity reached 90.73% and specificity 90.73%. A score of 2 points or above from any single item could be considered as the second minimum criterion for competence. CBTS-CYP offers a valid and reliable scale to evaluate the competence and adherence quality of CBT sessions with children and adolescents.

The why, what, when, who and how of assessing CBT competence to support lifelong learning

Abstract Assessment of cognitive behaviour therapy (CBT) competence is a critical component in ensuring optimal clinical care, supporting therapists’ skill acquisition, and facilitating continuing professional development. This article provides a framework to support trainers, assessors, supervisors and therapists when making decisions about selecting and implementing effective strategies for assessing CBT competence. The framework draws on the existing evidence base to address five central questions: Why assess CBT competence?; What is CBT competence?; When should CBT competence be assessed?; Who is best placed to assess CBT competence?; and How should CBT competence be assessed? Various methods of assessing CBT competence are explored and the potential benefits and challenges are outlined. Recommendations are made about which approach to use across different contexts and how to use these effectively to facilitate the acquisition, enhancement and evaluation of CBT knowledge and skills. Key learning aims After reading this article you will be able to: (1) Identify key issues about why, what, when, who and how to assess CBT competence and use this framework to guide decisions about the best strategy to use. (2) Be aware of the range of methods for assessing CBT competence and consider the main benefits and potential challenges of these. (3) Consider the most effective ways to implement CBT competence assessment strategies as a tool for evaluation and learning.

The quality of research exploring in-session measures of CBT competence: a systematic review.

Cognitive behavioural therapy (CBT) is in high demand due to its strong evidence base and cost effectiveness. To ensure CBT is delivered as intended in research, training and practice, fidelity assessment is needed. Fidelity is commonly measured by assessors rating treatment sessions, using CBT competence scales (CCSs). The current review assessed the quality of the literature examining the measurement properties of CCSs and makes recommendations for future research, training and practice. Medline, PsychINFO, Scopus and Web of Science databases were systematically searched to identify relevant peer-reviewed, English language studies from 1980 onwards. Relevant studies were those that were primarily examining the measurement properties of CCSs used to assess adult 1:1 CBT treatment sessions. The quality of studies was assessed using a novel tool created for this study, following which a narrative synthesis is presented. Ten studies met inclusion criteria, most of which were assessed as being 'fair' methodological quality, primarily due to small sample sizes. Construct validity and responsiveness definitions were applied inconsistently in the studies, leading to confusion over what was being measured. Although CCSs are widely used, we need to pay careful attention to the quality of research exploring their measurement properties. Consistent definitions of measurement properties, consensus about adequate sample sizes and improved reporting of individual properties are required to ensure the quality of future research.

Assessing panic disorder-specific competencies: evaluation of the Cognitive Therapy Competence Scale for panic disorder.

Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures. To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Competence Scale (CTCP) for panic disorder. CBT trainees (n = 60) submitted audio recordings of CBT for panic disorder that were scored on a generic competence measure, the Cognitive Therapy Scale - Revised (CTS-R), and the CTCP by markers with experience in CBT practice and evaluation. Trainees also provided pre- to post-treatment clinical outcomes on disorder-specific patient report measures for cases corresponding to their therapy recordings. The CTCP exhibited strong internal consistency (α = .79-.91) and inter-rater reliability (ICC = .70-.88). The measure demonstrated convergent validity with the CTS-R (r = .40-.54), although investigation into competence classification indicated that the CTCP may be more sensitive at detecting competence for panic disorder-specific CBT skills. Notably, the CTCP demonstrated the first indication of a relationship between therapist competence and clinical outcome for panic disorder (r = .29-.35); no relationship was found for the CTS-R. These findings provide initial support for the reliability and validity of the CTCP for assessing therapist competence in CBT for panic disorder and support the use of anxiety disorder-specific competence measures. Further investigation into the psychometric properties of the measure in other therapist cohorts and its relationship with clinical outcomes is recommended.

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.

Trainee self-assessment of cognitive behaviour therapy competence during and after training

Abstract Large-scale cognitive behavioural therapy (CBT) training and implementation programmes, such as the pioneering Improving Access to Psychological Therapies (IAPT) initiative in the UK, aim to develop a workforce of competent therapists who can deliver evidence-based interventions skilfully. Self-awareness of competence enables CBT therapists to accurately evaluate their clinical practice and determine professional development needs. The accuracy of self-assessed competence, however, remains unclear when compared with assessments conducted by markers with expertise in CBT practice and evaluation. This study investigated the relationship between self- and expert-rated competence – assessed via therapy recordings rated on the Cognitive Therapy Scale Revised (CTS-R) scale – for a large sample of IAPT CBT trainees during training and, for the first time, at post-training follow-up. CBT trainees (n = 150) submitted therapy recordings at baseline, mid-training and end-of-training. At 12+ month follow-up, a subset of former trainees (n = 30) submitted recordings from clinical practice. There were positive relationships (r = .27 to .56) between self and expert CTS-R scores at all time points. The proportion of tapes demonstrating significant agreement between self and expert ratings (CTS-R difference <5 points) increased significantly across training and remained stable at follow-up. Findings indicate that accurate self-awareness of competence can be developed during structured CBT training and retained in the workplace. These outcomes are encouraging given the importance of self-awareness to CBT practice and accreditation. Future investigation into the development and maintenance of accurate self-awareness of competence is warranted. Key learning aims (1) What is the relationship between self-ratings and expert ratings of CBT competence during training and at post-training follow-up? (2) Does agreement between self and expert competence ratings improve with CBT training? (3) How does agreement between self and expert ratings change across training for more- and less-competent trainees? (4) Can accurate self-awareness of competence be retained post-training in the workplace?

Multi-professional IAPT CBT training: clinical competence and patient outcomes.

There is international interest in the training of psychological therapists to deliver evidence-based treatment for common mental health problems. The UK Improving Access to Psychological Therapies (IAPT) programme, one of the largest training initiatives, relies on competent therapists to successfully deliver cognitive behaviour therapy (CBT) and promote good patient outcome. To evaluate an IAPT CBT training course by assessing if trainees' clinical skills improve during training and reach competency standards, and to report patient outcome for submitted training cases. To investigate a possible relationship between trainee competence and patient outcome. To explore professional differences during training. CBT trainee (n = 252) competence was assessed via audio recordings of therapy sessions at the beginning, middle and end of training. Patient pre- to post-treatment outcomes were extracted from submitted training cases (n = 1927). Differences in professional background were examined across competence, academic final grade and tutorial support. CBT trainees attained competence by the end of the course with 77% (anxiety recordings) and 72% (depression recordings) improving reliably. Training cases reported pre- to post-treatment effect sizes of 1.08-2.26 across disorders. CBT competence predicted a small variance in clinical outcome for depression cases. Differences in professional background emerged, with clinical psychologists demonstrating greater competence and higher academic grades. Trainees without a core professional background required more additional support to achieve competence. Part of a new CBT therapist workforce was successfully trained to deliver relatively brief treatment effectively. Trainees without a core profession can be successfully trained to competence, but may need additional support. This has implications for workforce training.

A systematic review exploring therapist competence, adherence, and therapy outcomes in individual CBT for children and young people

Objective: Whilst the evidence base for cognitive behavioural therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur are still unclear. This systematic review seeks to appraise the relationship between therapeutic outcomes in CBT and therapist adherence and competence, within the child and adolescent literature.Method: A systematic review was carried out, with five studies identified as meeting the inclusion criteria.Results: The literature is currently small and inconclusive. Amongst the studies reviewed, there were inconsistent findings, with minimal-to-no effect sizes found between adherence, competence, and outcomes.Conclusions: The current paucity of research in this area means that conclusions are currently limited. The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population. This is comparable with the current adult literature, where findings also remain inconclusive. Further research avenues are discussed.

Competence feedback improves CBT competence in trainee therapists: A randomized controlled pilot study

Objective: The development and improvement of therapeutic competencies are central aims in psychotherapy training; however, little is known about which training interventions are suitable for the improvement of competencies. Method: In the current pilot study, the efficacy of feedback regarding therapeutic competencies was investigated in cognitive behavioural therapy (CBT). Totally 19 trainee therapists and 19 patients were allocated randomly to a competence feedback group (CFG) or control group (CG). Two experienced clinicians and feedback providers who were blind to the treatment conditions independently evaluated therapeutic competencies on the Cognitive Therapy Scale at five treatment times (i.e., at Sessions 1, 5, 9, 13, and 17). Whereas CFG and CG included regular supervision, only therapists in the CFG additionally received written qualitative and quantitative feedback regarding their demonstrated competencies in conducting CBT during treatment. Results: We found a significant Time × Group interaction effect (η² = .09), which indicates a larger competence increase in the CFG in comparison to the CG. Conclusions: Competence feedback was demonstrated to be suitable for the improvement of therapeutic competencies in CBT. These findings may have important implications for psychotherapy training, clinical practice, and psychotherapy research. However, further research is necessary to ensure the replicability and generalizability of the findings.

Expert Insight into the Assessment of Competence in Cognitive-Behavioural Therapy: A Qualitative Exploration of Experts' Experiences, Opinions and Recommendations.

To offer insight into how cognitive-behavioural therapy (CBT) competence is defined, measured and evaluated and to highlight ways in which the assessment of CBT competence could be further improved, the current study utilizes a qualitative methodology to examine CBT experts' (N = 19) experiences of conceptualizing and assessing the competence of CBT therapists. Semi-structured interviews were used to explore participants' experiences of assessing the competence of CBT therapists. Interview transcripts were then analysed using interpretative phenomenological analysis in order to identify commonalities and differences in the way CBT competence is evaluated. Four superordinate themes were identified: (i) what to assess, the complex and fuzzy concept of CBT competence; (ii) how to assess CBT competence, selecting from the toolbox of assessment methods; (iii) who is best placed to assess CBT competence, expertise and independence; and (iv) pitfalls, identifying and overcoming assessment biases. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. Copyright © 2015 John Wiley & Sons, Ltd. A qualitative exploration of experts' experiences, opinions and recommendations for assessing the competence of CBT therapists. Semi-structured interviews were conducted and analysed using interpretive phenomenological analysis. Themes identified shed light on (i) what to assess; (ii) how to assess; (iii) who is best placed to assess; and (iv) common pitfalls. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings.

Investigating the relationship between competence and patient outcome with CBT

Little is understood about the relationship between therapist competence and the outcome of patients treated for common mental health disorders. Understanding the relationship between competence and patient outcome is of fundamental importance to the dissemination and implementation of Cognitive Behavioural Therapy (CBT). The current study extends existing literature by exploring the relationship between CBT competence and patient outcome in routine clinical practice within the framework of the British Government's Improving Access to Psychological Therapies (IAPT) programme. Participants comprised 43 therapists treating 1247 patients over a training period of one year. Results found little support of a general association between CBT competence and patient outcome; however significantly more patients of the most competent therapists demonstrated a reliable improvement in their symptoms of anxiety than would be expected by chance alone, and fewer experienced no reliable change. Conversely, significantly more patients treated by the least competent therapists experienced a reliable deterioration in their symptoms than would be expected. The implications of these results for the dissemination and implementation of CBT are discussed.

An investigation of the accuracy of therapists’ self‐assessment of cognitive‐behaviour therapy skills

The impact of cognitive behavioural therapy (CBT) interventions in routine clinical practice depends on those interventions being delivered competently. Since direct observation or independent assessment of therapists' skills are typically limited in routine clinical practice, the assessment of competence, and thus of the need for further training and/or supervision to improve competence, rests mainly on the individual therapist's self-assessment. To examine the accuracy of therapists' self-assessment of their CBT competence in relation to supervisors' assessments. Self-ratings on the Cognitive Therapy Scale (CTS; Young & Beck, 1980; 1988) from two groups of trainees on established cognitive therapy training courses (n= 64) were compared to supervisors' ratings of the same therapy sessions. There were moderate correlations between self- and supervisor assessments, and the previously reported over-estimation of CBT skills (Brosan, Reynolds, & Moore, 2008) was not replicated in the current sample. Instead, these groups showed under-estimation of their skills compared to supervisors' ratings, with the less-competent trainees' ratings not being significantly different from their supervisors' and the more competent trainees' ratings being significantly lower than those of their supervisors. Several possible explanations of the results are discussed and recommendations for ensuring the integrity of CBT delivered in routine clinical practice are made.

An evaluation of the effectiveness of Diploma-level training in cognitive behaviour therapy

BackgroundAs part of the UK government’s initiative to Increase Access to Psychological Therapies (see http://www.iapt.nhs.uk/for full details of the IAPT programme) there has been an expansion in the provision of post-graduate Diploma training in cognitive behaviour therapy (CBT). Previous evaluations of such training programmes have yielded mixed results but have been limited by small sample sizes and/or limited assessment measures. AimsTo evaluate the impact of a long-standing Diploma in CBT training programme on a variety of measures of CBT competence. MethodTrainees’ levels of CBT skill are compared at the beginning and end of CBT training. The effect of therapist factors such as age, professional background and gender on the development of CBT competence is also examined. ResultsResults show that trainees demonstrate higher levels of CBT skills after completing the training than they did before, with the majority achieving pre-determined criteria for competence. Trainees’ gender was not related to their performance but trainees’ age showed a negative association with CBT skill (older trainees performed worse). Trainees’ professional background also had an impact on their level of CBT competence, with trainees who were clinical psychologists demonstrating the highest levels of competence across a range of measures. ConclusionsCBT Diploma training leads to increases in the level of trainees’ CBT competence, with the majority achieving the levels demonstrated in research trials by the end of training. Thus, this training is likely to lead to improved outcomes for patients. Further research is needed to determine the most efficient ways of enhancing CBT skills.