A randomised controlled study of face-to-face versus internet-based teaching of CBT skills for healthcare professionals in Sudan.

BACKGROUND: A need has been identified for affordable and scalable methods for disseminating cognitive-behavioural therapy (CBT) to countries with barriers to traditional methods of teaching. OBJECTIVE: This study evaluated the effectiveness of internet-based teaching versus face-to-face teaching in improving the CBT theory, assessment, and formulation skills of a group of mental health practitioners in Khartoum, Sudan. METHOD: Participants (N = 36) were randomly assigned to (a) a 3 h live lecture, or (b) a computer-based multimedia recorded lecture of the same duration. Participants were rated before and after training for their ability to assess a simulated patient and construct a CBT formulation of the presenting difficulties. Participants also rated the feasibility and acceptability of the training they had received. RESULTS: Both teaching methods resulted in significant improvements in participants' abilities to carry out the assessment and formulation tasks. However, participants allocated to computer-based teaching performed better than those allocated to live teaching (between-groups effect size d = 0.26-0.74). Both teaching methods were rated as highly acceptable and feasible by participants. CONCLUSIONS: Computer-based teaching could offer a cheaper and effective method to help disseminate CBT to countries with limited resources and expertise, replacing and supplementing other costly traditional methods such as face-to-face teaching.

Nursing teachers' experiences of the process of recovery while participating in a group programme for reducing work-related stress: A qualitative content analysis.

Work-related stress is an increasing health problem among nursing teachers, contributing to health problems, disengagement and poor job satisfaction. Negative coping strategies impact on both teachers' and students' teaching-learning experiences. Several interventions have been developed to address work-related stress. There has been less focus on how nursing teachers can learn to recover from work-related stress before it has severe consequences for their health, and to understand it from a nursing perspective. The aim of this study was to explore how nursing teachers who participated in a cognitive relational group programme experienced the process of recovery from work-related stress. Data were collected by means of three focus groups and subjected to qualitative content analysis, resulting in three categories: relatedness, evoking the inner caregiver, and re-orientation in life. These categories were reflected on in relation to Benner and Wrubel's "primacy of caring" and synthesised into a metaphorical theme: "finding one's footings". The findings imply that the development of positive coping strategies as well as knowledge and understanding about psychological processes are vehicles in the process of recovery. We conclude that interventions also need to account for the process of recovery as related to an ontological level and the person's Being-in-the-World.

How Supervisees on a Foundation Course in CBT Perceive a Supervision Session and what they Bring Forward to the Next Therapy Session.

BACKGROUND: There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees' perspective. AIMS: The aim of the study was to acquire knowledge from the supervisees' perspective as to what in particular in the supervision process contributes to the therapy process. METHOD: Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants' written diaries after supervision and therapy sessions. RESULTS: Analyses of supervisees' experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was 'doing the right thing' was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. CONCLUSIONS: The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.

Development and psychometric evaluation of the Assessment of Core CBT Skills (ACCS): An observation-based tool for assessing cognitive behavioral therapy competence.

This article outlines the development and psychometric evaluation of the Assessment of Core CBT Skills (ACCS) rating scale. The ACCS aims to provide a novel assessment framework to deliver formative and summative feedback regarding therapists' performance within observed cognitive-behavioral treatment sessions, and for therapists to rate and reflect on their own performance. Findings from 3 studies are outlined: (a) a feedback study (n = 66) examining content validity, face validity and usability; (b) a focus group (n = 9) evaluating usability and utility; and (c) an evaluation of the psychometric properties of the ACCS in real world cognitive behavioral therapy (CBT) training and routine clinical practice contexts. Results suggest that the ACCS has good face validity, content validity, and usability and provides a user-friendly tool that is useful for promoting self-reflection and providing formative feedback. Scores on both the self and assessor-rated versions of the ACCS demonstrate good internal consistency, interrater reliability, and discriminant validity. In addition, ACCS scores were found to be correlated with, but distinct from, the Revised Cognitive Therapy Scale (CTS-R) and were comparable to CTS-R scores in terms of internal consistency and discriminant validity. In addition, the ACCS may have advantages over the CTS-R in terms of interrater reliability of scores. The studies also provided insight into areas for refinement and a number of modifications were undertaken to improve the scale. In summary, the ACCS is an appropriate and useful measure of CBT competence that can be used to promote self-reflection and provide therapists with formative and summative feedback. (PsycINFO Database Record

Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision.

OBJECTIVE: To investigate the effect of Internet-based training (IBT), with and without supervision, on therapists' (N = 61) cognitive-behavioral therapy (CBT) skills in routine clinical practice. METHOD: Participants were randomized into 3 conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW); (2) Internet-based training with CBT supervision via Skype (IBT-S); and (3) "delayed-training" controls (DTs), who did not receive the training until all data collection was completed. The IBT participants received access to training over a period of 3 months. CBT skills were evaluated at pre-, mid- and posttraining/wait using assessor competence ratings of recorded therapy sessions. RESULTS: Hierarchical linear analysis revealed that the IBT-S participants had significantly greater CBT competence at posttraining than did IBT-CW and DT participants at both the mid- and posttraining/wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training DTs. CONCLUSIONS: IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more-traditional "live" methods of training. There was no evidence for a significant effect of IBT without supervision over a nontraining control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice.

Randomized trial comparing Internet-based training in cognitive behavioural therapy theory, assessment and formulation to delayed-training control.

OBJECTIVE: There is a need for effective, scalable methods of training clinicians in evidence-based interventions, particularly for populations with significant barriers to accessing traditional methods of training (e.g., developing economies, non-English speaking geographically dispersed populations). Hence this study examined the effectiveness of Internet-based training (IBT) in cognitive behavioural therapy (CBT) theory, assessment and formulation for participants in Russia with limited previous knowledge or training in CBT. METHOD: Participants (N = 63) were randomized to either immediate IBT (approximately three hours over the course of one month) or a delayed training control group. Participants were assessed immediately prior to and following the training/delay on (a) standardized role-play of a CBT assessment and (b) ability to construct CBT formulation of the role-play 'patient'. In addition the feasibility and acceptability of the training was assessed. RESULTS: Responses indicated that translated and subtitled IBT training was perceived by participants to be feasible and acceptable. Following the training those allocated to IBT scored significantly higher on measures of CBT assessment and formulation skills (between group effects sizes of d = 0.77-1.10) than those allocated to the control group. Participants reported IBT to be a feasible and acceptable form of CBT dissemination. An adaptation of the CTS used to rate a standardized role-play assessment demonstrated good inter-rater reliability. CONCLUSIONS: IBT may be an effective and scalable method of CBT dissemination with particular potential for training CBT skills in populations with significant barrier to accessing traditional methods of training.

An investigation of the accuracy of therapists' self-assessment of cognitive-behaviour therapy skills.

BACKGROUND: 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. AIMS: To examine the accuracy of therapists' self-assessment of their CBT competence in relation to supervisors' assessments. METHOD: 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. RESULTS: 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. CONCLUSIONS: Several possible explanations of the results are discussed and recommendations for ensuring the integrity of CBT delivered in routine clinical practice are made.

Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance.

Cognitive behavior therapy's (CBT) demonstrated efficacy has prompted calls for its increased dissemination to routine clinical practice settings. For the widespread dissemination of CBT to be successful in achieving effects similar to the original efficacy trials, there must also be effective dissemination of CBT training practices. However, as yet, CBT training is not evidence-based. This review examines what can be learned from existing research into the efficacy and effectiveness of CBT training. Due to the paucity of research specifically investigating CBT training, CBT effectiveness and dissemination studies are also examined to glean information about potentially effective training practices. In order to draw conclusions about effective training practices, comparisons are drawn between studies according to the clinical outcomes that they achieved. Training approaches are compared according to dose and active training elements, and theoretical models of learning are applied to interpret the findings. The limitations of the existing literature are discussed, as well as recommendations for improving training research to meet the standards evident in treatment trials (e.g., random allocation, control conditions, self-report and blind assessment, and adherence monitoring). Finally, the process of developing efficacious CBT treatment protocols is offered as a template for developing evidence-based CBT training protocols.