CBT COMPETENCE IN NOVICE THERAPISTS IMPROVES ANXIETY OUTCOMES: Research Article: Competence and Adherence
Open accessAbstract
OBJECTIVE: This study explores the relationships between therapist variables (cognitive behavioral therapy [CBT] competence, and CBT adherence) and clinical outcomes of computer-assisted CBT for anxiety disorders delivered by novice therapists in a primary care setting. METHODS: Participants were recruited for a randomized controlled trial of evidence-based treatment, including computer-assisted CBT, versus treatment as usual. Therapists (anxiety clinical specialists; ACSs) were nonexpert clinicians, many of whom had no prior experience in delivering psychotherapy (and in particular, very little experience with CBT). Trained raters reviewed randomly selected treatment sessions from 176 participants and rated therapists on measures of CBT competence and CBT adherence. Patients were assessed at baseline and at 6-, 12-, and 18-month follow-ups on measures of anxiety, depression, and functioning, and an average Reliable Change Index was calculated as a composite measure of outcome. CBT competence and CBT adherence were entered as predictors of outcome, after controlling for baseline covariates. RESULTS: Higher CBT competence was associated with better clinical outcomes whereas CBT adherence was not. Also, CBT competence was inversely correlated with years of clinical experience and trended (not significantly, though) down as the study progressed. CBT adherence was inversely correlated with therapist tenure in the study. CONCLUSIONS: Therapist competence was related to improved clinical outcomes when CBT for anxiety disorders was delivered by novice clinicians with technology assistance. The results highlight the value of the initial training for novice therapists as well as booster training to limit declines in therapist adherence.
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- Authors
- Brown, L. A., Craske, M. G., Glenn, D. E., Stein, M. B., Sullivan, G., Sherbourne, C., Bystritsky, A., Welch, S. S., Campbell-Sills, L., Lang, A., Roy-Byrne, P., & Rose, R. D.
- Affiliations
- University of California, Los Angeles (US)
- University of California San Diego (US)
- RAND Corporation (US)
- Anxiety and Stress Reduction Center of Seattle; Seattle Washington
- Department of Psychiatry; University of California; San Diego California
- University of Washington and Harborview Center for Healthcare Improvement for Addictions; Mental Illness and Medically Vulnerable Populations (CHAMMP); Seattle Washington
- Corresponding author
- Rose, Raphael D.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2012-12-05
- Volume
- 30
- Issue
- 2
- Pages
- 97-115
- ISSN
- 1091-4269 (ISSN-L)
- PMC
- PMC3900410
- OpenAlex
- W2142703087
- Cited by
- 31
- References
- 57
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2021: 2 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 6 · 2014: 3 · 2013: 1
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (U01 MH070018, U01 MH058915, U01 MH057835, UO1 MH057858, U01 MH070022, K24 MH64122, K24 MH065324)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cognitive behavioral therapy, therapist competence, novice therapists, anxiety disorders, primary care, clinical outcomes, therapist training, booster training, therapist experience
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Delivery of Health Care, Female, Follow-Up Studies, Humans, Male, Middle Aged, Professional Competence, Psychiatric Status Rating Scales, Cognitive Behavioral Therapy, Treatment Outcome, Evidence-Based Medicine, Guideline Adherence
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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