Sustained implementation of cognitive-behavioral therapy for youth anxiety and depression: Long-term effects of structured training and consultation on therapist practice in the field.

Abstract

Identifying key factors that promote sustained implementation of evidence-based treatments (EBTs) after therapists receive training is critical for professional psychology. To address the field’s minimal knowledge in this area, the current study interviewed community based therapists (N = 23) who had completed intensive training in cognitive behavioral therapy (CBT) for either anxiety (Coping Cat) or depression (Primary and Secondary Control Enhancement Therapy [PASCET]) as part of a randomized effectiveness trial (Southam-Gerow et al., 2010; Weisz et al., 2009). Therapists were interviewed three to five years after completion of the initial trial, representing one of the longest-term follow-ups of therapist practices after training. Therapists viewed each protocol and their individual CBT strategies as effective and appropriate for the majority of their current anxiety and depression caseloads. However, therapists used parts of each protocol much more frequently than the protocol as a whole (i.e., 78.5% used parts of the Coping Cat and 7.5% used the whole protocol; 58.6% used parts of the PASCET and 20% used the whole protocol). Therapists reported using problem-solving the most and exposure exercises the least for current anxious cases; they used cognitive structuring the most and homework the least for current depression cases. Interventions that were more difficult to implement in usual care settings were less likely to be sustained. Future efforts should evaluate the characteristics and structure of EBTs that are most acceptable to therapists and should develop ongoing learning supports to maintain therapist skills and practice of EBT.