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

Published online by Cambridge University Press:  28 March 2019

Sheena Liness ,
Sarah Beale ,
Susan Lea ,
Suzanne Byrne ,
Colette R. Hirsch  and
David M. Clark
Sheena Liness*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Sarah Beale
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Susan Lea
Affiliation:
Vice Chancellor, University of Hull, Hull, UK
Suzanne Byrne
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Colette R. Hirsch
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
David M. Clark
Affiliation:
Department of Experimental Psychology, University of Oxford, Oxford, UK
*
*Corresponding author. Email: sheena.liness@kcl.ac.uk
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Abstract

Background:

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.

Aims:

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.

Method:

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.

Results:

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.

Conclusions:

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.

Keywords

anxietydepressionCBT trainingclinical outcomecompetenceIAPT
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 6 , November 2019 , pp. 672 - 685
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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Footnotes

§

Joint last authors due to equal contributions to the manuscript.

References

Alfonsson, S., Parling, T., Spännargård, Å., Andersson, G. and Lundgren, T. (2017). The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cognitive Behaviour Therapy, 47, 206–228.CrossRefGoogle ScholarPubMed
Baguley, C., Farrand, P., Hope, R., Leibowitz, J., Lovell, K., Lucock, M., et al. (2010). Good practice guidance on the use of self-help materials within IAPT services. Technical Report: IAPT. Retrieved from: http://eprints.hud.ac.uk/9017/ Google Scholar
Barnfield, T. V., Mathieson, F. M. and Beaumont, G. R. (2007). Assessing the development of competence during postgraduate cognitive-behavioral therapy training. Journal of Cognitive Psychotherapy, 21, 140–147.CrossRefGoogle Scholar
Benjamini, Y. and Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57, 289–300.CrossRefGoogle Scholar
Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., et al. (2001). The revised cognitive therapy scale (CTS-R): psychometric properties. Behavioural and Cognitive Psychotherapy, 29, 431–446.CrossRefGoogle Scholar
Branson, A., Shafran, R. and Myles, P. (2015). Investigating the relationship between competence and patient outcome with CBT. Behaviour Research and Therapy, 68, 19–26.CrossRefGoogle ScholarPubMed
Clark, D. M. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 14, 159–183.CrossRefGoogle ScholarPubMed
Clark, D.M., Canvin, L., Green, J., Layard, R., Pilling, S. and Janecka, M. (2017). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. The Lancet, 391, 679–686.CrossRefGoogle ScholarPubMed
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H. and Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). The British Journal of Psychiatry, 176, 379–386.CrossRefGoogle Scholar
Department of Health (2011). National Curriculum for High Intensity Cognitive Behavioural Therapy Courses. UK: NHS Digital.Google Scholar
Department of Health (2014). Improving Access to Psychological Therapies: Measuring Improvement and Recovery – Adult Services. Version 2. UK: NHS Digital.Google Scholar
Department of Health (2016a). Psychological Therapies: Annual Report on the Use of IAPT Services, England, 2015–16. UK: NHS Digital.Google Scholar
Department of Health (2016b). 2015 Adult IAPT Workforce Census Report. UK: NHS England and Health Education England.Google Scholar
Department of Health (2017). Improving Access to Psychological Therapies (IAPT) Executive Summary (March 2017). UK: NHS Digital.Google Scholar
Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A. and Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans affairs care. JAMA Psychiatry, 70, 949–955.CrossRefGoogle ScholarPubMed
Fairburn, C. G. and Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49, 373–378.CrossRefGoogle ScholarPubMed
Fairburn, C. G. and Patel, V. (2014). The global dissemination of psychological treatments: a road map for research and practice. American Journal of Psychiatry, 171, 495–498.CrossRefGoogle ScholarPubMed
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: the Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206.CrossRefGoogle Scholar
Forand, N. R., Evans, S., Haglin, D. and Fishman, B. (2011). Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective. Behavior Therapy, 42, 612–623.CrossRefGoogle ScholarPubMed
Ginzburg, D. M., Bohn, C., Höfling, V., Weck, F., Clark, D. M. and Stangier, U. (2012). Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder. Behaviour Research and Therapy, 50, 747–752.CrossRefGoogle ScholarPubMed
Gordon, P. K. (2006). A comparison of two versions of the Cognitive Therapy Scale. Behavioural and Cognitive Psychotherapy, 35, 343–353.CrossRefGoogle Scholar
Grey, N., Salkovskis, P., Quigley, A., Clark, D. M. and Ehlers, A. (2008). Dissemination of cognitive therapy for panic disorder in primary care. Behavioural and Cognitive Psychotherapy, 36, 509–520.CrossRefGoogle ScholarPubMed
Gyani, A., Shafran, R., Layard, R. and Clark, D. M. (2013). Enhancing recovery rates: lessons from year one of IAPT. Behaviour Research and Therapy, 51, 597–606.CrossRefGoogle ScholarPubMed
Jacobson, N. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12.CrossRefGoogle ScholarPubMed
James, I. A., Blackburn, I. M., Milne, D. L. and Reichelt, F. K. (2001). Moderators of trainee therapists’ competence in cognitive therapy. British Journal of Clinical Psychology, 40, 131–141.CrossRefGoogle ScholarPubMed
Jolley, S., Onwumere, J., Bissoli, S., Bhayani, P., Singh, G., Kuipers, E., et al. (2015). A pilot evaluation of therapist training in cognitive therapy for psychosis: therapy quality and clinical outcomes. Behavioural and Cognitive Psychotherapy, 43, 478–489.CrossRefGoogle ScholarPubMed
Karlin, B. E., Brown, G. K., Trockel, M., Cunning, D., Zeiss, A. M. and Taylor, C. B. (2012). National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs Health Care System: therapist and patient-level outcomes. Journal of Consulting and Clinical Psychology, 80, 707.CrossRefGoogle ScholarPubMed
Karlin, B. E. and Cross, G. (2014). From the laboratory to the therapy room: national dissemination and implementation of evidence-based psychotherapies in the US Department of Veterans Affairs Health Care System. American Psychologist, 69, 19.CrossRefGoogle Scholar
Kazantzis, N., Clayton, X., Cronin, T. J., Farchione, D., Limburg, K. and Dobson, K. S. (2018). The Cognitive Therapy Scale and Cognitive Therapy Scale-Revised as measures of therapist competence in cognitive behavior therapy for depression: relations with short and long term outcome. Cognitive Therapy and Research, 42, 385–397.CrossRefGoogle Scholar
Keen, A. J. and Freeston, M. H. (2008). Assessing competence in cognitive-behavioural therapy. British Journal of Psychiatry, 193, 60–64.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Lund, C., Tomlinson, M. and Patel, V. (2016). Integration of mental health into primary care in low-and middle-income countries: the PRIME mental healthcare plans. British Journal of Psychiatry, 208, s1–3.CrossRefGoogle ScholarPubMed
Mason, L., Grey, N. and Veale, D. (2016). My therapist is a student? The impact of therapist experience and client severity on cognitive behavioural therapy outcomes for people with anxiety disorders. Behavioural and Cognitive Psychotherapy, 44, 193–202.CrossRefGoogle ScholarPubMed
McManus, F., Westbrook, D., Vazquez-Montes, M., Fennell, M. and Kennerley, H. (2010). An evaluation of the effectiveness of diploma-level training in cognitive behaviour therapy. Behaviour Research and Therapy, 48, 1123–1132.CrossRefGoogle ScholarPubMed
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle ScholarPubMed
Morris, S. B. and DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 105.CrossRefGoogle ScholarPubMed
National Institute of Health and Care Excellence (NICE) (2011). Common Mental Health Disorders: Identification and Pathways to Care. Clinical Guideline CG123. Retrieved from: https://www.nice.org.uk/guidance/cg123/evidence/full-guideline-181771741 Google Scholar
NHS England (2016). Achieving Better Access to Mental Health Services by 2020. London: NHS England. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/361648/mental-health-access.pdf Google Scholar
Öst, L. G., Karlstedt, A. and Widén, S. (2012). The effects of cognitive behavior therapy delivered by students in a psychologist training program: an effectiveness study. Behavior Therapy, 43, 160–173.CrossRefGoogle Scholar
Patel, V., Weobong, B., Weiss, H. A., Anand, A., Bhat, B., Katti, B., et al. (2017). The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. The Lancet, 389, 176–185.CrossRefGoogle ScholarPubMed
Rakovshik, S. G. and McManus, F. (2010). Establishing evidence-based training in cognitive behavioral therapy: a review of current empirical findings and theoretical guidance. Clinical Psychology Review, 30, 496–516.CrossRefGoogle ScholarPubMed
Reichelt, F. K., James, I. A. and Blackburn, I. M. (2003). Impact of training on rating competence in cognitive therapy. Journal of Behavior Therapy and Experimental Psychiatry, 34, 87–99.CrossRefGoogle ScholarPubMed
Rogers, W. (1994). Regression standard errors in clustered samples. Stata Technical Bulletin, 3(13), 19–23.Google Scholar
Rosen, R. C., Ruzek, J. I. and Karlin, B. E. (2017). Evidence-based training in the era of evidence-based practice: challenges and opportunities for training of PTSD providers. Behaviour Research and Therapy, 88, 37–48.CrossRefGoogle ScholarPubMed
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C. and Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853.CrossRefGoogle ScholarPubMed
Shear, M. K., Rucci, P., Williams, J., Frank, E., Grochocinski, V., Vander Bilt, J., et al. (2001). Reliability and validity of the Panic Disorder Severity Scale: replication and extension. Journal of Psychiatric Research, 35, 293–296.CrossRefGoogle Scholar
Simons, A. D., Padesky, C. A., Montemarano, J., Lewis, C. C., Murakami, J., Lamb, K., et al. (2010). Training and dissemination of cognitive behavior therapy for depression in adults: a preliminary examination of therapist competence and client outcomes. Journal of Consulting and Clinical Psychology, 78, 751.CrossRefGoogle ScholarPubMed
Singla, D. R., Kohrt, B. A., Murray, L. K., Anand, A., Chorpita, B. F. and Patel, V. (2017). Psychological treatments for the world: lessons from low- and middle-income countries. Annual Review of Clinical Psychology, 13, 149–181.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Van Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S. M., Pian, J., et al. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low-and middle-income countries. Cochrane Database of Systemic Reviews, 11, CD009149.Google Scholar
Webb, C. A., DeRubeis, R. J. and Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200–211.CrossRefGoogle ScholarPubMed
Weck, F., Kaufmann, Y. M. and Höfling, V. (2017). Competence feedback improves CBT competence in trainee therapists: a randomized controlled pilot study. Psychotherapy Research, 27, 501–509.CrossRefGoogle ScholarPubMed
Weiss, D. S. and Marmar, C. R. (1996). The Impact of Event Scale– Revised. In Wilson, J. and Keane, T. M. (eds), Assessing Psychological Trauma and PTSD (pp. 399–411). New York: Guilford.Google Scholar
Westbrook, D., Sedgwick-Taylor, A., Bennett-Levy, J., Butler, G. and McManus, F. (2008). A pilot evaluation of a brief CBT training course: impact on trainees’ satisfaction, clinical skills and patient outcomes. Behavioural and Cognitive Psychotherapy, 36, 569–579.CrossRefGoogle Scholar
Young, J. E. and Beck, A. T. (1980). Cognitive Therapy Scale: Rating manual. Unpublished manuscript. Philadelphia, PA, USA: University of Pennsylvania.Google Scholar
Zarafonitis-Müller, S., Kuhr, K. and Bechdolf, A. (2014). The relationship between therapist’s competence and adherence to outcome in cognitive-behavioural therapy– results of a meta-analysis. Fortschritte der Neurologie Psychiatrie, 82, 502–510.Google Scholar
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