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Therapist Training and Supervision in Clinical Trials: Implications for Clinical Practice

Published online by Cambridge University Press:  06 April 2010

Anthony D. Roth ,
Stephen Pilling  and
Jenny Turner
Anthony D. Roth*
Affiliation:
University College London, UK
Stephen Pilling
Affiliation:
University College London, UK
Jenny Turner
Affiliation:
University College London, UK
*
Reprint requests to Anthony D. Roth, Joint Course Director, Doctorate in Clinical Psychology, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. E-mail: a.roth@ucl.ac.uk A supplementary file detailing trials is available online in the table of contents for this issue: http://journals.cambridge.org/jid_BCP
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Abstract

Background: Researchers in clinical trials usually pay close attention to therapist selection, training, supervision and monitoring, but the extent of this input has not been systematically documented. Aims: To describe the extent of training and supervision activity within clinical trials, and to consider any implications for transporting therapies from research to routine clinical contexts. Method: Twenty-seven randomized studies examining the efficacy of CBT interventions for people with depression or anxiety disorders were selected on the basis of their quality and impact on the field. Published and unpublished sources were used to gather information about therapist selection, training and supervision within these trials. Results: The review identified the extent of investment by researchers in assuring therapist expertise, adherence and competence. It also indicated inconsistencies in the clarity with which this input was reported. Conclusions: The ubiquity of intervention-specific training in research contexts risks being overlooked when commissioning evidence-based therapies in routine practice. This has clear implications for the likely effectiveness of interventions. Greater consistency in the reporting of training in clinical trials may help to draw attention to the role of training and supervision in maximizing clinical outcomes.

Keywords

Therapist competencetrainingsupervision
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 38 , Issue 3 , May 2010 , pp. 291 - 302
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

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References

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List of trials

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O'Reardon, J. P., Lovett, ML, Gladis, M. M., Brown, L. L. and Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.CrossRefGoogle ScholarPubMed
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunne, D. L. and Jacobson, N. S. (2006). Randomised trial of behavioural activation, cognitive therapy and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.CrossRefGoogle ScholarPubMed
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J. and Parloff, M. B. (1989). National Institute of Mental Health Treatment of Depression Collaborative Program: general effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.CrossRefGoogle ScholarPubMed
Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M. and Tuason, V. B. (1992). Cognitive therapy and pharmacotherapy for depression: singly and in combination. Archives of General Psychiatry, 49, 774–781.CrossRefGoogle ScholarPubMed
Jarrett, R. B., Schaffer, M., McIntire, D., Witt-Browder, A., Kraft, D. and Risser, R. C. (1999). Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Archives of General Psychiatry, 56, 431–437.CrossRefGoogle ScholarPubMed
Jarrett, R. B., Kraft, D., Doyle, J., Foster, B. M., Eaves, G. G. and Silver, P. C. (2001). Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Archives of General Psychiatry, 58, 381–388.CrossRefGoogle ScholarPubMed
*Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H. and Zajecka, J. (2000). A comparison of nefazodone, the cognitive behavioral analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462–1470.CrossRefGoogle ScholarPubMed
Barlow, D. H., Rapee, R. M. and Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23, 551–570.CrossRefGoogle Scholar
Borkovec, T. and Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611–619.CrossRefGoogle ScholarPubMed
Butler, G., Fennell, M., Robson, P. and Gelder, M. (1991). Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167–175.CrossRefGoogle ScholarPubMed
Durham, R. C., Murphy, T., Allan, T., Richard, K., Trevling, L. R. and Fenton, G. W. (1994). Cognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder. British Journal of Psychiatry, 165, 315–323.CrossRefGoogle Scholar
Ladouceur, R., Dugas, M. J., Freeston, M. H., Leger, E., Gagnon, F. and Thibodeau, N. (2000). Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957–964.CrossRefGoogle Scholar
Öst, L. G. and Breitholtz, E. (2000). Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38, 777–790.CrossRefGoogle ScholarPubMed
*Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M. and Campbell, H. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067.CrossRefGoogle ScholarPubMed
*Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L. and Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefGoogle ScholarPubMed
Cottraux, J., Note, I., Albuisson, E., Yao, S. N., Note, B., Mollard, E., Bonasse, F., Jalenques, I., Guérin, J. and Coudert, A. J. (2000). Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial. Psychotherapy and Psychosomatics, 69, 137–146.CrossRefGoogle ScholarPubMed
*Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L. J. and Becker, R. E. (1990). Cognitive behavioral group treatment for social phobia: comparison with a credible placebo control. Cognitive Therapy and Research, 14, 1–23.CrossRefGoogle Scholar
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., Schneier, F. R., Holt, C. S., Welkowitz, L. A., Juster, H. R., Campeas, R., Bruch, M. A., Cloitre, M., Fallon, B. and Klein, D. F. (1998). Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Archives of General Psychiatry, 55, 1133–1141.CrossRefGoogle ScholarPubMed
Barlow, D. H., Gorman, J. M., Shear, M. K. and Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA, 283, 2529–2536.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P. and Gelder, M. G. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759–769.CrossRefGoogle ScholarPubMed
Sharp, D. M., Power, K. G., Simpson, R. J., Swanson, V., Moodie, E., Anstee, J. A. and Ashford, J. J. (1996). Fluvoxamine, placebo and cognitive behavior therapy used alone and in combination in the treatment of panic disorder and agoraphobia. Journal of Anxiety Disorders, 10, 219–242.CrossRefGoogle Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C. and Mayou, R. (2003). A randomized controlled trial of cognitive therapy, self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry. 60, 1024–1032.CrossRefGoogle Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F. and Fennell, M. (2005). Cognitive therapy for PTSD: development and evaluation. Behaviour Research and Therapy, 43, 413–431.CrossRefGoogle ScholarPubMed
*Foa, E. B., Rothbaum, B. O., Riggs, D. S. and Murdock, T. B. (1991). Treatment of PTSD in rape victims: a comparison between cognitive-behavioral procedures and counselling. Journal of Consulting and Clinical Psychology, 59, 715–723.CrossRefGoogle Scholar
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A. and Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194–200.CrossRefGoogle ScholarPubMed
Monson, C., Schnurr, P., Resick, P., Friedman, M., Young-Xu, Y. and Stevens, S. P. (2006). Cognitive Processing Therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907.CrossRefGoogle ScholarPubMed
Resick, P. A., Nishith, P., Weaver, T., Astin, M. and Feuer, C. A. (2002). Comparison of Cognitive-Processing Therapy with Prolonged Exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.CrossRefGoogle Scholar
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O'Reardon, J. P., Lovett, ML, Gladis, M. M., Brown, L. L. and Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.CrossRefGoogle ScholarPubMed
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., Atkins, D. C., Dunne, D. L. and Jacobson, N. S. (2006). Randomised trial of behavioural activation, cognitive therapy and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.CrossRefGoogle ScholarPubMed
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J. and Parloff, M. B. (1989). National Institute of Mental Health Treatment of Depression Collaborative Program: general effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.CrossRefGoogle ScholarPubMed
Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M. and Tuason, V. B. (1992). Cognitive therapy and pharmacotherapy for depression: singly and in combination. Archives of General Psychiatry, 49, 774–781.CrossRefGoogle ScholarPubMed
Jarrett, R. B., Schaffer, M., McIntire, D., Witt-Browder, A., Kraft, D. and Risser, R. C. (1999). Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Archives of General Psychiatry, 56, 431–437.CrossRefGoogle ScholarPubMed
Jarrett, R. B., Kraft, D., Doyle, J., Foster, B. M., Eaves, G. G. and Silver, P. C. (2001). Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Archives of General Psychiatry, 58, 381–388.CrossRefGoogle ScholarPubMed
*Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H. and Zajecka, J. (2000). A comparison of nefazodone, the cognitive behavioral analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462–1470.CrossRefGoogle ScholarPubMed
Barlow, D. H., Rapee, R. M. and Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23, 551–570.CrossRefGoogle Scholar
Borkovec, T. and Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611–619.CrossRefGoogle ScholarPubMed
Butler, G., Fennell, M., Robson, P. and Gelder, M. (1991). Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167–175.CrossRefGoogle ScholarPubMed
Durham, R. C., Murphy, T., Allan, T., Richard, K., Trevling, L. R. and Fenton, G. W. (1994). Cognitive therapy, analytic psychotherapy and anxiety management training for generalized anxiety disorder. British Journal of Psychiatry, 165, 315–323.CrossRefGoogle Scholar
Ladouceur, R., Dugas, M. J., Freeston, M. H., Leger, E., Gagnon, F. and Thibodeau, N. (2000). Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology, 68, 957–964.CrossRefGoogle Scholar
Öst, L. G. and Breitholtz, E. (2000). Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy, 38, 777–790.CrossRefGoogle ScholarPubMed
*Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M. and Campbell, H. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067.CrossRefGoogle ScholarPubMed
*Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L. and Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.CrossRefGoogle ScholarPubMed
Cottraux, J., Note, I., Albuisson, E., Yao, S. N., Note, B., Mollard, E., Bonasse, F., Jalenques, I., Guérin, J. and Coudert, A. J. (2000). Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial. Psychotherapy and Psychosomatics, 69, 137–146.CrossRefGoogle ScholarPubMed
*Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L. J. and Becker, R. E. (1990). Cognitive behavioral group treatment for social phobia: comparison with a credible placebo control. Cognitive Therapy and Research, 14, 1–23.CrossRefGoogle Scholar
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., Schneier, F. R., Holt, C. S., Welkowitz, L. A., Juster, H. R., Campeas, R., Bruch, M. A., Cloitre, M., Fallon, B. and Klein, D. F. (1998). Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome. Archives of General Psychiatry, 55, 1133–1141.CrossRefGoogle ScholarPubMed
Barlow, D. H., Gorman, J. M., Shear, M. K. and Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA, 283, 2529–2536.CrossRefGoogle ScholarPubMed
Clark, D. M., Salkovskis, P. M., Hackmann, A., Middleton, H., Anastasiades, P. and Gelder, M. G. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759–769.CrossRefGoogle ScholarPubMed
Sharp, D. M., Power, K. G., Simpson, R. J., Swanson, V., Moodie, E., Anstee, J. A. and Ashford, J. J. (1996). Fluvoxamine, placebo and cognitive behavior therapy used alone and in combination in the treatment of panic disorder and agoraphobia. Journal of Anxiety Disorders, 10, 219–242.CrossRefGoogle Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C. and Mayou, R. (2003). A randomized controlled trial of cognitive therapy, self-help booklet, and repeated assessment as early interventions for PTSD. Archives of General Psychiatry. 60, 1024–1032.CrossRefGoogle Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F. and Fennell, M. (2005). Cognitive therapy for PTSD: development and evaluation. Behaviour Research and Therapy, 43, 413–431.CrossRefGoogle ScholarPubMed
*Foa, E. B., Rothbaum, B. O., Riggs, D. S. and Murdock, T. B. (1991). Treatment of PTSD in rape victims: a comparison between cognitive-behavioral procedures and counselling. Journal of Consulting and Clinical Psychology, 59, 715–723.CrossRefGoogle Scholar
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A. and Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194–200.CrossRefGoogle ScholarPubMed
Monson, C., Schnurr, P., Resick, P., Friedman, M., Young-Xu, Y. and Stevens, S. P. (2006). Cognitive Processing Therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907.CrossRefGoogle ScholarPubMed
Resick, P. A., Nishith, P., Weaver, T., Astin, M. and Feuer, C. A. (2002). Comparison of Cognitive-Processing Therapy with Prolonged Exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879.CrossRefGoogle Scholar
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