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Implementing Transdiagnostic Cognitive Behavioral Psychotherapy in Adult Public Behavioral Health: A Pilot Evaluation of the Feasibility of the Common Elements Treatment Approach (CETA)

  • Roselyn PetersonEmail author
  • Doyanne Darnell
  • Lucy Berliner
  • Shannon Dorsey
  • Laura Murray
  • Maria Monroe-DeVita
Article
  • 159 Downloads

Abstract

Few evidence-based psychotherapies are provided in adult public behavioral health (PBH), despite the need for such treatments. The common elements treatment approach (CETA) was developed for use by lay providers in low- and middle-income countries and may have relevance in PBH given its unique application with individuals with multiple diagnoses including PTSD, depression, and anxiety. This study utilized data collected as part of the implementation of CETA in 9 PBH agencies in Washington State with 58 providers, including a 2-day workshop and 6 months of consultation. Outcomes included provider-perceived skill in CETA delivery, training and consultation completion rates, and perceived appropriateness of CETA for clients. Thirty-nine (67%) providers completed requirements for training and consultation, and delivered CETA to a total of 56 clients. Perceived competence in delivering CETA improved over time, as well as client symptom scores. CETA shows promise for feasible and effective implementation within US-based PBH systems.

Keywords

Transdiagnostic treatment Cognitive-behavioral psychotherapy, evidence-based practices Adult public behavioral health Comorbid disorders 

Notes

Acknowledgements

The authors would like to acknowledge USAID/Victims of Torture Fund as the funder for the design, development, and early feasibility and effectiveness trials of CETA in Lower- and Middle-Income Countries.

Compliance with Ethical Standards

Conflict of Interest

The fourth and fifth authors are CETA developers; both have been paid to provide CETA trainings. The remaining authors declare no conflicts of interest.

References

  1. 1.
    Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Review of Public Health. 2008;29:115–129.Google Scholar
  2. 2.
    Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2005;62(6):593–602.Google Scholar
  3. 3.
    Ratzliff A, Unutzer J, Katon W, et al. Integrated care: Creating effective mental and primary health care teams. Vol 1. Hoboken, New Jersey: Wiley; 2016.Google Scholar
  4. 4.
    Nixon RD, Resick PA, Nishith P. An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. Journal of Affective Disorders. 2004;82(2):315–320.Google Scholar
  5. 5.
    Post LM, Zoellner LA, Youngstrom E, et al. Understanding the relationship between co-occurring PTSD and MDD: symptom severity and affect. Journal of Anxiety Disorders. 2011;25(8):1123–1130.Google Scholar
  6. 6.
    Rytwinski NK, Scur MD, Feeny NC, et al. The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. Journal of Traumatic Stress. 2013;26(3):299–309.Google Scholar
  7. 7.
    Substance Abuse and Mental Health Services Administration [SAMHSA]. SAMHSA’s national registry of evidence-based programs and practices. 2010.Google Scholar
  8. 8.
    Institute of Medicine. Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders. 2015.Google Scholar
  9. 9.
    Mitchell PF. Evidence-based practice in real-world services for young people with complex needs: new opportunities suggested by recent implementation science. Children and Youth Services Review. 2011;33(2):207–216.Google Scholar
  10. 10.
    Institute of Medicine. Treatment of PTSD: An assessment of the evidence. 2007.Google Scholar
  11. 11.
    Hoagwood K, Burns BJ, Kiser L, et al. Evidence-based practice in child and adolescent mental health services. Psychiatric Services. 2001;52(9):1179–1189.Google Scholar
  12. 12.
    Drake RE, Goldman HH, Leff HS, et al. Implementing evidence-based practices in routine mental health service settings. Psychiatric Services. 2001;52(2):179–182.Google Scholar
  13. 13.
    Shafran R, Clark DM, Fairburn CG, et al. Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy. 2009;47(11):902–909.Google Scholar
  14. 14.
    President’s New Freedom Commission on Mental Health. Report of the president's new freedom commission on mental health. Retrieved from http://govinfo.library.unt.edu/mentalhealthcommission/reports/reportshtm . 2003.
  15. 15.
    Substance Abuse and Mental Health Services Administration. Medicaid Handbook: Interface with Behavioral Health Services. Vol No. SMA-13-4773. Rockville, MD: HHS Publication 2013.Google Scholar
  16. 16.
    Washington State Institute for Public Policy. Outcomes for adult public mental health clients in Washington State: A five-year longitudinal analysis. 2009.Google Scholar
  17. 17.
    Butler AC, Chapman JE, Forman EM, et al. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review. 2006;26(1):17–31.Google Scholar
  18. 18.
    Kanter J. Clinical case management: definition, principles, components. Hosp Community Psychiatry. 1989;40(4):361–368.Google Scholar
  19. 19.
    Stewart RE, Adams DR, Mandell DS, et al. The perfect storm: collision of the business of mental health and the implementation of evidence-based practices. Psychiatric Services. 2016;67(2):159–161.Google Scholar
  20. 20.
    Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental health and Mental Health Services Research. 2010;37(1–2):15–26.Google Scholar
  21. 21.
    Olmstead T, Carroll KM, Canning-Ball M, et al. Cost and cost-effectiveness of three strategies for training clinicians in motivational interviewing. Drug and Alcohol Dependence. 2011;116(1–3):195–202.Google Scholar
  22. 22.
    Substance abuse and mental health services administration [SAMHSA]. Contracting for managed substance abuse and mental health services: A guide for public purchasers. Technical Assistance Publication Series. 1998;22.Google Scholar
  23. 23.
    Arizpe M, Christiansen B, Ford DE, et al. Burden of illness: costs and consequences of our fragmented mental health care system. Journal of Managed Care and Specialty Pharmacy. 2006.Google Scholar
  24. 24.
    Thase ME, Friedman ES, Biggs MM, et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. American Journal of Psychiatry. 2007;164(5):739–752.Google Scholar
  25. 25.
    Lopez MA, Basco MR. Feasibility of dissemination of cognitive behavioral therapy to Texas community mental health centers. Journal of Behavioral Health Services & Research. 2011;38(1):91–104.Google Scholar
  26. 26.
    Rosen RC, Ruzek JI, Karlin BE. Evidence-based training in the era of evidence-based practice: challenges and opportunities for training of PTSD providers. Behaviour Research and Therapy 2017;88:37–48.Google Scholar
  27. 27.
    Miller M, Fumia D, Kay N. Updated inventory of evidence-based, research-based, and promising practices prevention and intervention services for adult behavioral health. 2015(15-01-4101).Google Scholar
  28. 28.
    Barlow DH, Bullis JR, Comer JS, et al. Evidence-based psychological treatments: an update and a way forward. Annual Review of Clinical Psychology. 2013;9:1–27.Google Scholar
  29. 29.
    McHugh RK, Barlow DH. The dissemination and implementation of evidence-based psychological treatments. A review of current efforts. American Psychologist 2010;65(2):73–84.Google Scholar
  30. 30.
    McHugh RK, Murray HW, Barlow DH. Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: the promise of transdiagnostic interventions. Behaviour Research and Therapy 2009;47(11):946–953.Google Scholar
  31. 31.
    Creed TA, Frankel SA, German RE, et al. Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative. Journal of Consulting and Clinical Psychology 2016;84(12):1116–1126.Google Scholar
  32. 32.
    Ellard KK, Fairholme CP, Boisseau CL, et al. Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive and Behavioral Practice 2010;17:88–101.Google Scholar
  33. 33.
    Farchione TJ, Fairholme CP, Ellard KK, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy 2012;43(3):666–678.Google Scholar
  34. 34.
    Chorpita BF, Daleiden EL, Weisz JR. Modularity in the design and application of therapeutic interventions. Applied & Preventive Psychology 2005;11:141–156.Google Scholar
  35. 35.
    Chorpita BF, Daleiden EL, Weisz JR. Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Mental Health Services Research. 2005;7(1):5–20.Google Scholar
  36. 36.
    Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: Guilford Press; 2004.Google Scholar
  37. 37.
    Weisz JR, Ugueto AM, Herren J, et al. Kernels vs. ears, and other questions for a science of treatment dissemination. Clinical Psychology (New York). 2011;18(1):41–46.Google Scholar
  38. 38.
    Dorsey S, Berliner L, Lyon AR, et al. A statewide common elements initiative for children's mental health. Journal of Behavioral Health Services & Research. 2016.Google Scholar
  39. 39.
    Barlow DH, Farchione TJ, Bullis JR, et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2017;74(9):875–884.Google Scholar
  40. 40.
    Boisseau CL, Farchione TJ, Fairholme CP, et al. The development of the unified protocol for the transdiagnostic treatment of emotional disorders: a case study. Cognitive and Behavioral Practice 2010;17(1):102–113.Google Scholar
  41. 41.
    Wilamowska ZA, Thompson-Hollands J, Fairholme CP, et al. Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety 2010;27(10):882–890.Google Scholar
  42. 42.
    Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy 2008;39(3):242–250.Google Scholar
  43. 43.
    Norton PJ, Philipp LM. Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy (Chic) 2008;45(2):214–226.Google Scholar
  44. 44.
    Weiss WM, Murray LK, Zangana GA, et al. Community-based mental health treatments for survivors of torture and militant attacks in Southern Iraq: a randomized control trial. BMC Psychiatry 2015;15:249.Google Scholar
  45. 45.
    Grubaugh AL, Zinzow HM, Paul L, et al. Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clinical Psychology Review 2011;31(6):883–899.Google Scholar
  46. 46.
    Fulop G, Strain JJ, Vita J, et al. Impact of psychiatric comorbidity on length of hospital stay for medical/surgical patients: a preliminary report. American Journal of Psychiatry 1987;144(7):878–882.Google Scholar
  47. 47.
    Murray LK, Dorsey S, Haroz E, et al. A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cognitive and Behavioral Practice 2014;21(2):111–123.Google Scholar
  48. 48.
    Borntrager CF, Chorpita BF, Higa-McMillan C, et al. Provider attitudes toward evidence-based practices: are the concerns with the evidence or with the manuals? Psychiatric Services 2009;60(5):677–681.Google Scholar
  49. 49.
    Bolton P, Lee C, Haroz EE, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among burmese refugees in Thailand. PLoS Med 2014;11(11):e1001757.Google Scholar
  50. 50.
    Murray LK, Tol W, Jordans M, et al. Dissemination and implementation of evidence based, mental health interventions in post conflict, low resource settings. Intervention (Amstelveen) 2014;12(Suppl 1):94–112.Google Scholar
  51. 51.
    Wolitzky-Taylor K, Fenwick K, Lengnick-Hall R, et al. A preliminary exploration of the barriers to delivering (and receiving) exposure-based cognitive behavioral therapy for anxiety disorders in adult community mental health settings. Community Mental Health Journal 2018.Google Scholar
  52. 52.
    Murray LK, Dorsey S, Bolton P, et al. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. International Journal of Mental Health Systems 2011;5(1):30.Google Scholar
  53. 53.
    Zatzick DF, Koepsell T, Rivara FP. Using target population specification, effect size, and reach to estimate and compare the population impact of two PTSD preventive interventions. Psychiatry 2009;72(4):346–359.Google Scholar
  54. 54.
    Beidas RS, Edmunds JM, Marcus SC, et al. Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatric Services 2012;63(7):660–665.Google Scholar
  55. 55.
    Beidas RS, Cross W, Dorsey S. Show me, don't tell me: behavioral rehearsal as a training and analogue fidelity tool. Cognitive & Behavioral Practice 2014;21(1):1–11.Google Scholar
  56. 56.
    Dorsey S, Lyon AR, Pullmann MD, et al. Behavioral rehearsal for analogue fidelity: feasibility in a state-funded children's mental health initiative. Administration and Policy in Mental Health and Mental Health Services Research 2016.Google Scholar
  57. 57.
    Wiltsey Stirman S, Kimberly J, Cook N, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation Science 2012;7:17.Google Scholar
  58. 58.
    EBP Technologies LLC. EBP Toolkit. https://www.ebptoolkit.com/ . 2017.
  59. 59.
    Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research 2011;38(2):65–76.Google Scholar
  60. 60.
    Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics 2009;42(2):377–381.Google Scholar
  61. 61.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 2001;16(9):606–613.Google Scholar
  62. 62.
    American Psychiatric Association., American Psychiatric Association. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders : DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  63. 63.
    Lowe B, Kroenke K, Herzog W, et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders 2004;81(1):61–66.Google Scholar
  64. 64.
    Foa EB, Riggs D, Dancu D, et al. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 1993;6:459–474.Google Scholar
  65. 65.
    Foa EB, Tolin DF. Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. Journal of Traumatic Stress 2000;13(2):181–191.Google Scholar
  66. 66.
    IBM Corp. IBM SPSS Statistics for Windows (Version 19.0). 2010.Google Scholar
  67. 67.
    James IA, Blackburn IM, Milne DL, et al. Moderators of trainee therapists' competence in cognitive therapy. British Journal of Clinical Psychology 2001;40(Pt 2):131–141.Google Scholar
  68. 68.
    DeViva JC. The effects of full-day and half-day workshops for health care providers in techniques for increasing resistant clients' motivation. Professional Psychology, Research and Practice 2006;37(1):83–90.Google Scholar
  69. 69.
    Mathieson FM, Barnfield T, Beaumont G. Are we as good as we think we are? Self-assessment versus other forms of assessment of competence in psychotherapy. Cognitive Behaviour Therapist 2009;2:43–50.Google Scholar
  70. 70.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 1977;84(2):191–215.Google Scholar
  71. 71.
    Luborsky L, Diguer L, Seligman DA, et al. The researcher's own therapy allegiances: a "wild card" in comparisons of treatment efficacy. Clinical Psychology Science and Practice 1999;6(1):95–106.Google Scholar
  72. 72.
    Addis ME, Jacobson NS. A closer look at the treatment rationale and homework compliance in cognitive behavioral therapy for depression. Cognitive Therapy and Research 2000;24(3):313–326.Google Scholar
  73. 73.
    Wiltsey Stirman S, Miller CJ, Toder K, et al. Perspectives on cognitive therapy training within community mental health settings: implications for clinician satisfaction and skill development. Depression Research Treatment 2012;391084.Google Scholar
  74. 74.
    Green CA, Duan N, Gibbons RD, et al. Approaches to mixed methods dissemination and implementation research: methods, strengths, caveats, and opportunities. Administration and Policy in Mental Health and Mental Health Services Research 2015;42(5):508–523.Google Scholar
  75. 75.
    Handley MA, Lyles CR, McCulloch C, et al. Selecting and improving quasi-experimental designs in effectiveness and implementation research. Annual Review of Public Health. 2018.Google Scholar
  76. 76.
    Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. The Journal of the American Board of Family Medicine 2011;24(5):589–596.Google Scholar
  77. 77.
    Dorsey S, Kerns SEU, Lucid L, et al. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implementation Science 2018;13(1):19.Google Scholar
  78. 78.
    Dorsey S, Pullmann MD, Kerns SEU, et al. The juggling act of supervision in community mental health: implications for supporting evidence-based treatment. Administration and Policy in Mental Health and Mental Health Services Research 2017;44(6):838–852.Google Scholar
  79. 79.
    Woltmann EM, Whitley R, McHugo GJ, et al. The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services 2008;59(7):732–737.Google Scholar

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of Central FloridaOrlandoUSA
  2. 2.Department of Psychiatry & Behavioral SciencesUniversity of WashingtonSeattleUSA
  3. 3.Harborview Center for Sexual Assault and Traumatic StressUniversity of Washington MedicineSeattleUSA
  4. 4.Department of PsychologyUniversity of WashingtonSeattleUSA
  5. 5.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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