Clinical translation of Cognitive Behavioural Therapy for anxiety and depression - Adapted for Brain Injury (CBT-ABI): How do we train competent clinicians?
Dana Wong, Adam McKay, Nikolaos Kazantzis & Jennie Ponsford
International Journal of Cognitive Therapy
What the study is about
Depression and anxiety are common following acquired brain injury (ABI) and can be effectively treated using cognitive behaviour therapy (CBT) that has been adapted to compensate for cognitive difficulties (CBT-ABI– as outlined in the CBT-ABI manual available from ASSBI Resources!) However, effective delivery of CBT-ABI requires a specialised skill set. Training clinicians to deliver CBT-ABI is therefore a crucial step in effective translation of this intervention into widespread clinical practice.
What we did
This study evaluated the outcome of didactic (instruction-based) and experiential (skill-based) training on competencies in delivering CBT-ABI. Participants were 39 registered psychologists who attended a day-long ASSBI workshop on using CBT-ABI to treat anxiety and depression after brain injury, which included knowledge-building, observational learning (i.e., videos of CBT-ABI) and skill-based (e.g., role play) content. Fourteen participants completed three additional supervision sessions reviewing audio recordings of their use of CBT-ABI with clients they saw in their workplaces. Training outcomes were measured using surveys rating the usefulness of the various workshop components; a checklist of competencies in CBT-ABI on which participants rated themselves pre- and post-workshop and post-supervision; and the Cognitive Therapy Scale (CTS), used by supervisors and a blinded expert to evaluate supervisees’ skills.
What we found
Participant-rated confidence and competence in delivering CBT-ABI significantly improved following workshop training. Examples of CBT modifications for ABI, case descriptions and videos of CBT-ABI in action were consistently rated as the most helpful elements of the workshop.
Self-rated competencies did not show further change after supervision. CTS ratings of the supervisor, but not the blinded expert, showed significant improvement after short-term supervision. The authors surmised that a longer period of supervision may have been necessary for greater impact on competencies. Nevertheless, at 16-month follow up, self-rated competency gains were maintained; and encouragingly, therapist confidence and competence were no longer major barriers to using CBT-ABI in the workplace. These findings suggest targeted training that includes opportunities for observational and experiential learning is important for clinical translation of this evidence-based intervention.
The authors would like to acknowledge and thank the psychologists who participated in the study and the individuals with brain impairment who consented to have their therapy sessions recorded for supervision. We would like to thank Dr Kerrie Haines, who provided supervision for some of the study participants, and Dr Lillian Nejad, who was our expert CTS rater. This research was supported by the Moving Ahead NHMRC Centre of Research Excellence in Brain Recovery.