Supervision for treatment of depression: An experimental study of the role of therapist gender and anxiety

Simpson-Southward, Chloe; Waller, Glenn; Hardy, Gillian E.

doi:10.1016/j.brat.2015.11.013

Cited by 10 publications

(7 citation statements)

References 36 publications

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“…There is also growing evidence for the association between supervision and better outcomes for both clinicians and their clients (Rakovshik et al, 2016). However, the sparse previous studies on the effect on therapist behaviour and client outcome shows ambiguous results (Simpson-Southward et al, 2016;Zarbock et al, 2009), and the methodological shortcomings of this research make it difficult to identify the specific supervision features that constitute best practices (Bearman et al, 2017). In recent years, there has been an increased focus on ensuring supervisor competence and effective supervision practice in both evidence-based clinical supervision (Milne and Reiser, 2012) and competency-based supervision (Falender and Shafranske, 2007).…”

Section: Clinical Supervisionmentioning

confidence: 99%

Providing objective feedback in supervision in motivational interviewing: results from a randomized controlled trial

Beckman

Forsberg²,

Lindqvist

et al. 2019

Behav. Cogn. Psychother.

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Background:The effects of the use of objective feedback in supervision on the supervisory relationship and skill acquisition is unknown.Aims:The objective of this study was to evaluate the effects of two different types of objective feedback provided during supervision in motivational interviewing (MI) on: (a) the supervisory relationship, including potential feelings of discomfort/distress, provoked by the supervision sessions, and (b) the supervisees’ skill acquisition.Method:Data were obtained from a MI dissemination study conducted in five county councils across five county councils across Sweden. All 98 practitioners recorded sessions with standardized clients and were randomized to either systematic feedback based on only the behavioral component of a feedback protocol, or systematic feedback based on the entire protocol.Results:The two different ways to provide objective feedback did not negatively affect the supervisory relationship, or provoke discomfort/distress among the supervisees, and the group that received the behavioural component of the feedback protocol performed better on only two of the seven skill measures.Conclusions:Objective feedback does not seem to negatively affect either the supervisor–supervisee working alliance or the supervisees’ supervision experience. The observed differences in MI skill acquisition were small, and constructive replications are needed to ascertain the mode and complexity of feedback that optimizes practitioners’ learning, while minimizing the sense of discomfort and distress.

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Section: Clinical Supervisionmentioning

confidence: 99%

Providing objective feedback in supervision in motivational interviewing: results from a randomized controlled trial

Beckman

Forsberg²,

Lindqvist

et al. 2019

Behav. Cogn. Psychother.

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“…Clinical supervision has been suggested to have a positive effect on clinical outcomes, but the results of published studies are not consistent: for example, Bambling et al (2006) reported a positive effect on patient outcomes, whereas White & Winstanley (2010) reported no significant effects. One of the few studies to have examined the effect of clinical supervision on therapists’ delivery of CBT to patients with depression found that the therapists’ gender and their anxiety levels both influenced the supervisors’ focus in supervision, suggesting that supervisors show biases in the way they support the work of different clinicians (Simpson-Southward 2016). Thus, there is a need to increase our understanding of the potential effect of clinical supervision on treatment effectiveness and drop-out rates in cognitive therapy and CBT.…”

Section: Reducing Drop-out Rates and Improving Outcomesmentioning

confidence: 99%

Treatment outcomes in depression: reducing drop-out rates in cognitive therapy

Pentaraki¹

2018

BJPsych advances

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SUMMARYAlthough cognitive therapy is a promising treatment for depression, high drop-out rates and, conversely, the specific elements that make the intervention effective continue to puzzle practising clinicians. This article discusses both therapistrelated factors (including competence and competencies) and patient-related factors (such as engagement in therapy and external logistical problems with attendance) that are related to drop-out and suggests practical ways to address them and improve outcomes. It examines cognitive and behavioural elements of manualised cognitive therapy and discusses findings relating to cognitive-behavioural therapy (CBT) in particular. LEARNING OBJECTIVES• Understand factors associated with high dropout rates in the cognitive therapy of depression and ways to reduce them • Learn about treatment integrity in cognitive therapy of depression and its relationship to the clinical outcome • Identify specific cognitive therapy techniques associated with patients' improvement in depressionDepression, or major depressive disorder (MDD), is defined in DSM-5 as an illness that affects mood, thinking and behaviour and it is characterised by feelings of sadness and loss of interest in previously pleasurable activities (American Psychiatric Association 2013). It is a potentially chronic condition and DSM-5 includes new diagnostic conceptualisations of the illness: the new diagnostic criteria for depressive disorders assume that most individuals with chronic depression or MDD will fulfil the criteria for dysthymia, so chronic depression and dysthymia have been merged into the diagnostic category of persistent depressive disorders (PDD). Nevertheless, not all individuals with chronic depression/MDD will meet the diagnostic criteria for PDD (American Psychiatric Association 2013; Uher 2014). People who have experienced MDD have a high risk of relapse during the first 6 months after symptom remission. Those who have been prescribed antidepressant medication are therefore advised to continue the antidepressant for at least 6 months after remission. In a study comparing relapse rates following successful treatment with medication or cognitive therapy, Hollon et al (2005) found that 70% of those who had responded to antidepressants relapsed within 12 months of medication withdrawal, whereas only 31% of responders to cognitive therapy relapsed during that period. The authors thus concluded that cognitive therapy had more enduring results than antidepressants in MDD treatment and relapse prevention. A metaanalysis by Cuijpers et al (2013) that compared the treatment efficacy of psychotherapies and pharmacotherapy found that cognitive-behavioural therapy (CBT) plus medication was slightly better than CBT alone. This suggests the need for more studies to clarify the effects of addition of antidepressants to cognitive therapy and CBT. Cognitive therapy for depressionCognitive therapy as a component of CBT uses cognitive restructuring techniques to change the individual's negative and maladaptive thinking. C...

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“…CBT therapists who received more supervision or had greater levels of self-esteem were more likely to use these non-CBT techniques. These findings might imply that supervisory drift is occurring (Simpson-Southward et al, 2016;Simpson-Southward et al, 2017), and that therapists have greater self-belief and do not see as strong a need to focus on evidence-based approaches.…”

Section: Discussionmentioning

confidence: 98%

Psychotherapists’ reports of technique use when treating anxiety disorders: factors associated with specific technique use

Parker

Waller

2019

tCBT

Self Cite

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Cognitive behavioural therapy (CBT) is the most efficacious and effective psychological intervention for treating anxiety disorders. Behavioural techniques, in particular exposure-based techniques, are fundamental to positive outcomes. However, research suggests that these techniques are either not used or are under-used when treating anxiety disorders. This study assesses therapists’ reported use of CBT techniques in the treatment of anxiety disorders, and explores which therapist variables influence technique use. A total of 173 CBT therapists completed measures on their demographics, routine therapy practices in treating anxiety disorders, and internal states (e.g. self-esteem). These data were analysed to see how often therapists employed particular techniques and the correlates of the use of those techniques. Behavioural techniques (e.g. exposure) were the least utilized set of core CBT skills, being used less often than non-CBT techniques. The under-utilization of these key techniques was associated with greater levels of increased inhibitory anxiety amongst therapists. Supervision and therapists’ self-esteem were both positively associated with the use of non-CBT techniques. While this study established what CBT therapists purport to use in routine practice with anxious populations, further research is needed to assess the association between adherence (or lack thereof) and client outcomes, and the factors that drive non-adherence.Key learning aimsAs a result of reading this paper, the reader should: (1)Learn about what psychotherapists report as occurring in routine care for individuals with anxiety and related disorders.(2)Know the potential therapist traits that influence the use of CBT techniques.(3)Gain knowledge to help explain to clients why previous therapy may not have been effective.(4)Develop a richer understanding of what factors may influence their own therapeutic practice.

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Supervision for treatment of depression: An experimental study of the role of therapist gender and anxiety

Cited by 10 publications

References 36 publications

Providing objective feedback in supervision in motivational interviewing: results from a randomized controlled trial

Providing objective feedback in supervision in motivational interviewing: results from a randomized controlled trial

Treatment outcomes in depression: reducing drop-out rates in cognitive therapy

Psychotherapists’ reports of technique use when treating anxiety disorders: factors associated with specific technique use

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