Investigating the relationship between competence and patient outcome with CBT

Abstract

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.

A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy

“…Future research should include an examination of these potentially important factors. Finally, we employed the CTRS, the most commonly-used measure of competence for cognitive therapy in both research and training programs, but researchers have noted limitations to this measure, including its emphasis on general competency rather than competency in discrete CT skills and difficulty achieving high inter-rater reliability (Branson et al 2015). …”

“…Next, we tested for noninferiority of the group versus individual consultation strategies (Blackwelder 2004 ; D’Agostino et al 2003 ; Nacasch et al 2014), examining whether the difference between the groups at post-consultation is smaller than a predetermined clinically meaningful difference (i.e., the noninferiority margin [“delta”]). To estimate a difference that would be clinically meaningful, the deltas were determined using the criterion for statistically significant and reliable change in competence established in a recent evaluation of a training program for CT, a difference of 4.5 points on the CTRS (Branson et al 2015). We would regard a difference of less than 4.5 as supporting the hypothesis of non inferiority.…”

Attitudes to Group Assessments: Prospective Psychotherapists’ Experiences of Being Assessed by Fellow Students

“…The extensive research concerning treatments has not yet provided sufficient evidence and guidelines concerning therapist training [4]. Further there is even less scientific evidence for how these skills and abilities should be operationalized, learned, evaluated and assessed [8] [9] [10] [11]. Bandura [12] argued that psychotherapy is a learning process and, therefore, greater effort should be made to develop treatment methods derived from knowledge of learning and motivation.…”

“…In this project general therapist competence, CBT specific competence, and diagnosis specific competence have been defined and described. Further research has also examined the relationship between therapists' behaviors and treatment outcomes [9] [20] [21], but it has not yet been possible to draw any clear conclusions from those studies.…”

Technology: Bridging the Gap from Research to Practice

“…Acquiring a high level of clinical expertise may be important in order to reach the efficacy rates observed in randomized trials (Branson, Shafran, & Myles, 2015;Franklin et al, 2013). However, it has been estimated that it would take 10 years to reach an expert skill level at 20 therapy hours per week-assuming someone is practicing "correctly" (Gallo et al, 2013;Gladwell, 2008).…”