Hostname: page-component-745bb68f8f-kw2vx Total loading time: 0 Render date: 2025-01-28T02:27:53.088Z Has data issue: false hasContentIssue false
  • English
  • Français

The Relationship between Competence and Patient Outcome with Low-Intensity Cognitive Behavioural Interventions

Published online by Cambridge University Press:  14 September 2017

Amanda Branson ,
Pamela Myles ,
Mishka Mahdi  and
Roz Shafran
Amanda Branson*
Affiliation:
School of Psychology and CLS, University of Reading, Earley Gate, Reading
Pamela Myles
Affiliation:
School of Psychology and CLS, University of Reading, Earley Gate, Reading
Mishka Mahdi
Affiliation:
University College London Great Ormond Street Institute of Child Health, Gower Street, London
Roz Shafran
Affiliation:
University College London Great Ormond Street Institute of Child Health, Gower Street, London
*
Correspondence to Amanda Branson, University of Reading, Earley Gate, Reading RG6 6AL, United Kingdom. E-mail: a.branson@reading.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients’ symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.

Keywords

IAPTtrainingdepressionanxietylow-intensityPWPpsychological well-being practitioner
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 1 , January 2018 , pp. 101 - 114
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders IV. Washington DC.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. doi: 10.1891/088983907780851586 Google Scholar
Bennett-Levy, J. (2010). Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.Google 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. doi: https://doi.org/10.1016/j.brat.2015.03.002 CrossRefGoogle ScholarPubMed
Cuijpers, P. and Schuurmans, J. (2007). Self-help interventions for anxiety disorders: an overview. Current Psychiatry Reports, 9, 284–290.CrossRefGoogle ScholarPubMed
Department of Health (2010). Realising the Benefits: IAPT at Full Roll Out. London: Department of Health. Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_112982 (accessed 2 August 2017).Google Scholar
Fairburn, C. G. and Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49, 373–378. doi: 10.1016/j.brat.2011.03.005 Google Scholar
Ferriter, M., Kaltenthaler, E., Parry, G. and Beverley, C. (2008). Computerised CBT: a review. Mental Health Today, 193, 30–31.Google Scholar
Ginzburg, D. M., Bohn, C., Höfling, V. and Weck, F. (2012). Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder. Behaviour Research and Therapy, 50, 747–752. doi: 10.1016/j.brat.2012.09.001 Google Scholar
Green, H., Barkham, M., Kellett, S. and Saxon, D. (2014). Therapist effects and IAPT Psychological Well-being Practitioners (PWPs): A multilevel modelling and mixed methods analysis. Behaviour Research and Therapy, 63, 43–54. doi: https://doi.org/10.1016/j.brat.2014.08.009 Google Scholar
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. doi: https://doi.org/10.1016/j.brat.2013.06.004 Google Scholar
IAPT (2011). The IAPT Data Handbook: Guidance on recording and monitoring outcomes to support local evidence-based practice. London. Available at: http://webarchive.nationalarchives.gov.uk/20160302160058/http://www.iapt.nhs.uk/silo/files/iapt-data-handbook-v2.pdf Google Scholar
Jacobson, N. S. and Truax, P. A. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Keen, A. J. A. and Freeston, M. H. (2008). Assessing competence in cognitive-behavioural therapy. British Journal of Psychiatry, 193, 60–64. doi: 10.1192/bjp.bp.107.038588 CrossRefGoogle ScholarPubMed
Kobak, K. A., Wolitzky-Taylor, K., Craske, M. G. and Rose, R. D. (2017). Therapist training on cognitive behavior therapy for anxiety disorders using internet-based technologies. Cognitive Therapy and Research, 41, 252–265. doi: 10.1007/s10608-016-9819-4 Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Manring, J., Beitman, B. D. and Dewan, M. J. (2003). Evaluating competence in psychotherapy. Academic Psychiatry, 27, 136–144. doi: 10.1176/appi.ap.27.3.136 Google Scholar
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
Muse, K. and McManus, F. (2013). A systematic review of methods for assessing competence in cognitive-behavioural therapy. Clinical Psychology Review, 33, 484–499. doi: 10.1016/j.cpr.2013.01.010 Google Scholar
Digital, NHS (2017). Improving access to psychological therapies (IAPT). Available at: http://content.digital.nhs.uk/catalogue/PUB23186/IAPT-month-oct-2016-exec-sum.pdf (accessed 2 August 2017).Google Scholar
NICE (2011). Common Mental Health Disorders: Identification and Pathways to Care. Clinical Guideline 123. London: The British Psychological Society and The Royal College of Psychiatrists. Available at: https://www.nice.org.uk/guidance/cg123 Google Scholar
Okiishi, J. C., Lambert, M. J., Nielsen, S. and Olgles, B. (2003). Waiting for Supershrink: an empirical analysis of therapist effects. Clinical Psychology and Psychotherapy, 10, 361–373.Google Scholar
Rakovshik, S. G., McManus, F., Westbrook, D. and Kholmogorova, A. B. (2013). Randomized trial comparing Internet-based training in cognitive behavioural therapy theory, assessment and formulation to delayed-training control. Behaviour Research and Therapy, 51, 231–239. doi: 10.1016/j.brat.2013.01.009 Google Scholar
Richards, D. A. and Whyte, M. (2009). ReachOut. National Programme Educator Materials to Support the Delivery of Training for Psychological Wellbeing Practitioners Delivering Low Intensity Interventions (2nd edn). London: Rethink.Google Scholar
Roth, A. D. and Pilling, S. (2008). Using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36, 129–147. doi: 10.1017/s1352465808004141 CrossRefGoogle Scholar
Saxon, D. and Barkham, M. (2012). Patterns of therapist variability: therapist effects and the contribution of patient severity and risk. Journal of Consulting and Clinical Psychology, 80, 535–546.CrossRefGoogle ScholarPubMed
Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F. and Carroll, K. M. (2005). We don't train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115. doi: 10.1037/0022-006x.73.1.106 Google Scholar
Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Statistical Methods in Medical Research, 7, 301–317.CrossRefGoogle ScholarPubMed
Shrout, P. E. and Fleiss, J. L. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86, 420–428.Google Scholar
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.Google Scholar
Trepka, C., Rees, A., Shapiro, D. A., Hardy, G. E. and Barkham, M. (2004). Therapist competence and outcome of cognitive therapy for depression. Cognitive Therapy and Research, 28, 143–157.Google Scholar
Turpin, G. (2008). Improving Access to Psychological Therapies (IAPT). Paper presented at the DCP Managers’ Conference, Doncaster.Google Scholar
UCL (2015). National Curriculum for the Education of Psychological Well-being Practitioners, 3rd edn. Available at: https://www.ucl.ac.uk/pals/research/cehp/research-groups/core/pwp-review/docs/PWPREVIE_-curriculum 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. doi: 10.1037/a0018912.supp 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. doi: 10.1017/S1352465808004608 Google Scholar
Williams, C. H. J. (2015). Improving Access to Psychological Therapies (IAPT) and treatment outcomes: epistemological assumptions and controversies. Journal of Psychiatric and Mental Health Nursing, 22, 344–351. doi: 10.1111/jpm.12181 Google Scholar
Ye, F. (2010). Change scores. In Salkind, N. J. (ed), Encyclopedia of Research Design. Thousand Oaks, CA: SAGE Reference Online.Google Scholar
Submit a response

Comments

No Comments have been published for this article.