The progress cascading model: A scalable model for teaching and mentoring graduate trainees in exposure therapy

Balkhi, Amanda M.; Reid, Adam M.; Guzick, Andrew G.; Geffken, Gary R.; McNamara, Joseph P. H.

doi:10.1016/j.jocrd.2016.02.005

Cited by 11 publications

(14 citation statements)

References 43 publications

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“…Therapists attended weekly group and individual supervision to discuss cases. For more information about the training model, see Balkhi, Reid, Guzick, Geffken, and McNamara (2016).…”

Section: Methodsmentioning

confidence: 99%

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

Guzick

Reid

Balkhi³

et al. 2018

Behav Modif

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Violating expectancies during exposure therapy is proposed to promote inhibitory learning and improved treatment outcomes. Because people tend to overestimate how distressing emotionally challenging situations will be, violating expectations of distress may be an intuitive way to promote treatment outcome during exposure-based cognitive-behavioral therapy (CBT). This study evaluated overpredictions of distress during exposure tasks in 33 youth with obsessive-compulsive disorder (OCD; ages 8-17) participating in CBT. Youth with more variable prediction accuracy and a higher proportion of overpredictions experienced more rapid symptom reduction, b = −0.29, p = .002. Underpredictions were less common toward the end of therapy as youth experienced less severe OCD, b = 0.12, p= .001. Findings suggest that although youth often accurately predict the intensity of exposure, overpredictions are common as well. The frequency of these overpredictions promoted treatment outcome, supporting expectancy violations as one indicator of inhibitory learning during exposure therapy.

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“…Therapists attended weekly group and individual supervision to discuss cases. For more information about the training model, see Balkhi, Reid, Guzick, Geffken, and McNamara (2016).…”

Section: Methodsmentioning

confidence: 99%

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

Guzick

Reid

Balkhi³

et al. 2018

Behav Modif

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“…The Coping Cat program is a good candidate for benchmarking as it is comprised of two distinct phases (skill-building, exposure; Kendall & Hedtke, 2006). Exposure is considered to be more difficult to deliver than skill-building interventions (Balkhi, Reid, Guzick, Geffken, & McNamara, 2016), so it is possible to evaluate whether treatment integrity varies across these two phases. We selected two randomized controlled trials (RCTs), one conducted in a research setting (Kendall et al, 2008) and the other in community settings (Southam-Gerow et al, 2010) that both employed the Coping Cat program.…”

mentioning

confidence: 99%

“…Second, we examined whether the dose and trajectory of adherence and competence changed over the skill-building and exposure phases of ICBT. Exposure is considered a difficult therapeutic intervention that requires intensive training (Balkhi et al, 2016), so it is possible that adherence and competence may vary across these two phases of ICBT.…”

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confidence: 99%

Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders

McLeod

Southam‐Gerow

Jensen‐Doss

et al. 2017

Journal of Clinical Child & Adolescent Psychology

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Evidence-based treatments (EBTs) for youth are typically developed and established through studies in research settings designed to ensure treatment integrity, that is, protocol adherence and competence by therapists. An important question for implementation science is how well integrity is maintained when these EBTs are delivered in community settings. The present study investigated whether the integrity achieved by therapists in community settings achieved a benchmark set by therapists in a research setting when they delivered the same EBT-an individual cognitive-behavioral treatment (ICBT) for youth anxiety. Therapists (N = 29; 68.97% White; 13.79% male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.35% White; 52.94% male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols were the same across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess ICBT adherence and competence. Both adherence and competence were higher in the research setting. Group differences in competence were consistent across treatment, but differences in adherence were most pronounced when treatment shifted to exposure, widely viewed as the most critical component of ICBT. When using the benchmarks from the research setting, therapists from the community settings fell short for indices of adherence and competence. However, given differences between therapists and clients, as well as the fact that treatment outcomes were similar across settings, our findings raise questions about whether it is appropriate to use treatment integrity benchmarks from research settings for community.

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“…As such, there have been calls for more early clinical training in treatment modalities such as ET (Callahan and Watkins, 2018;Klepac et al, 2012). The progressive cascading model (PCM; Balkhi et al, 2016) is one of the few described methods of practicum training for novices in ET. In the PCM, ET is taught through a hierarchical structure and is based on a 'train-the-trainer' model, where individuals play different roles in the delivery of ET based on their comfort, understanding of principles, ability to utilize skills, autonomy, and ability to lead (Balkhi et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…The progressive cascading model (PCM; Balkhi et al, 2016) is one of the few described methods of practicum training for novices in ET. In the PCM, ET is taught through a hierarchical structure and is based on a 'train-the-trainer' model, where individuals play different roles in the delivery of ET based on their comfort, understanding of principles, ability to utilize skills, autonomy, and ability to lead (Balkhi et al, 2016). In practice, individuals with limited experience are given lower levels of responsibility which gradually increase as training progresses.…”

Section: Introductionmentioning

confidence: 99%

The effects of an exposure therapy training program for pre-professionals in an intensive exposure-based summer camp

McCarty

Cooke

Lazaroe

et al. 2022

tCBT

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Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed. Key learning aims (1) How can training of CBT techniques such as exposure occur prior to graduate education? (2) Can self-efficacy in conducting exposures meaningfully increase in an experiential training of pre-professionals? (3) How does an individual’s tolerance of disgust impact feelings of competence conducting exposures?

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The progress cascading model: A scalable model for teaching and mentoring graduate trainees in exposure therapy

Cited by 11 publications

References 43 publications

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

Benchmarking Treatment Adherence and Therapist Competence in Individual Cognitive-Behavioral Treatment for Youth Anxiety Disorders

The effects of an exposure therapy training program for pre-professionals in an intensive exposure-based summer camp

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