Clinicians’ Perspectives on Cognitive Therapy in Community Mental Health Settings: Implications for Training and Implementation
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Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.
KeywordsEvidence-based psychosocial treatments Cognitive therapy Dissemination and implementation
The preparation of this article was funded in part by National Institute of Mental Health grants K99-MH080100, T32MH019836, P20 MH71905and R24MH070698, and the NIMH and VA-funded Implementation Research Institute through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institutes of Health or the Department of Veterans Affairs.
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- Aarons, G., Cafri, G., Lugo, L., & Sawitzky, A. (2010). Expanding the domains of attitudes towards evidence-based practice: The Evidence based practice attitude scale-50. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-010-0302-3
- Aarons, G. A., & Sawitzky, A. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 289–301. doi: 10.1007/s10488-006-0039-1.PubMedCrossRefGoogle Scholar
- Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Journal of Consulting and Clinical Psychology, 77(2), 270–280. doi: 10.1037/a0013223.PubMedCrossRefGoogle Scholar
- Becker, K. D., & Stirman, S. W. (2011). The science of training in evidence-based treatments in the context of implementation programs: Current status and prospects for the future. Administration and Policy in Mental Health and Mental Health Services Research, 38, 317–322. doi: 10.1007/s10488-011-0361-0.Google Scholar
- Cook, J. M., Biyanova, T., & Coyne, J. C. (2009). Barriers to adoption of new treatments: An internet study of practicing community psychotherapists. Administration and Policy in Mental Health and Mental Health Services Research, 36(2), 83–90. doi: 10.1007/s10488-008-0198-3.PubMedCrossRefGoogle Scholar
- Crits-Christoph, P., Siqueland, L., Chittams, J., Barber, J. P., Beck, A. T., Frank, A., et al. (1998). Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence. Journal of Consulting and Clinical Psychology, 66(3), 484–492. doi: 10.1037/0022-006X.66.3.484.PubMedCrossRefGoogle Scholar
- Davidson, K., Norrie, J., Tyrer, P., Gumley, A., Tata, P., Murray, H., et al. (2006). The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of Personality Disorders, 20(5), 450–465. doi: 10.1521/pedi.2006.20.5.450.PubMedCrossRefGoogle Scholar
- DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409. Retrieved at http://archpsyc.ama-assn.org/cgi/content/full/62/4/417.
- Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60(10), 1024. Retrieved at http://archpsyc.ama-assn.org/cgi/content/full/60/10/1024.
- Gittelsohn, J., Steckler, A., Johnson, C. C., Pratt, C., Grieser, M., Pickrel, J., et al. (2006). Formative research in school and community-based health programs and studies: “State of the art” and the TAAG approach. Health Education & Behavior, 33(1), 25–39. doi: 10.1177/1090198105282412.CrossRefGoogle Scholar
- Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine Publishing Company.Google Scholar
- Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., et al. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537. doi: 10.1037/a0019160.PubMedCrossRefGoogle Scholar
- Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., Mayberg, S., et al. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124. doi: 10.1007/s10488-007-0152-9.PubMedCrossRefGoogle Scholar
- Grant, P. M., Huh, G. A., Perivoliotis, D., Stolar, N., & Beck, A. T. (2011). A randomized trial to evaluate the efficacy of cognitive therapy for low functioning patients with schizophrenia. Archives of General Psychiatry, 69(2), 121–127. doi: 10.1001/archgenpsychiatry.2011.129.PubMedCrossRefGoogle Scholar
- Helfrich, C. D., Damschroder, L. J., Hagedorn, H. J., Daggett, G. S., Sahay, A., Ritchie, M., et al. (2010). A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework. Implementation Science, 5, 82. doi: 10.1186/1748-5908-5-82.PubMedCrossRefGoogle Scholar
- Kilmer, B., Eibner, C., Ringel, J. S., & Pacula, R. L. (2011). Invisible wounds, visible savings? Using microsimulation to estimate the costs and savings associated with providing evidence-based treatment for PTSD and depression to veterans of operation enduring freedom and operation Iraqi freedom. Psychological Trauma: Theory, Research, Practice, and Policy, 3(2), 201. doi: 10.1037/a0020592.CrossRefGoogle Scholar
- Lam, D. H., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., & Sham, P. (2003). A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Archives of General Psychiatry, 60(2), 145. Retrieved from http://archpsyc.ama-assn.org/cgi/reprint/60/2/145.
- Levitt, J. T., Malta, L. S., Martin, A., Davis, L., & Cloitre, M. (2007). The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack. Behaviour Research and Therapy, 45(7), 1419–1433. doi: 10.1016/j.brat.2007.01.004.PubMedCrossRefGoogle Scholar
- Lundgren, L., Amodeo, M., Cohen, A., Chassler, D., & Horowitz, A. (2011). Modifications of evidence-based practices in community-based addiction treatment organizations: A qualitative research study addictive behaviors. Addictive Behaviors, 36(6), 630–635. doi: 10.1016/j.addbeh.2011.01.003.PubMedCrossRefGoogle Scholar
- Malik, N., Kingdon, D., Pelton, J., Mehta, R., & Turkington, D. (2009). Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. The Journal of Clinical Psychiatry, 70(2), 201–207. doi: 10.4088/JCP.07m03990.PubMedCrossRefGoogle Scholar
- Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Administration and Policy in Mental Health and Mental Health Services Research, 35(1), 21–37. doi: 10.1007/s10488-007-0144-9.PubMedCrossRefGoogle Scholar
- Palinkas, L. A., Schoenwald, S. K., Hoagwood, K., Landsverk, J., Chorpita, B. F., & Weisz, J. R. (2008). An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. Psychiatric Services, 59(7), 738–746. doi: 10.1176/appi.ps.59.7.738.PubMedCrossRefGoogle Scholar
- Resick, P. A., Galovski, T. E., Uhlmansiek, M. O. B., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243. doi: 10.1037/0022-006X.76.2.243.PubMedCrossRefGoogle Scholar
- Riggs, S., Stirman, S. W., & Beck, A. T. (2012). Training community mental health agencies in cognitive therapy for schizophrenia. The Behavior Therapist, 35, 34–39. Retrieved from http://www.abct.org/docs/PastIssue/35n2.pdf
- Schoenwald, S. K., Chapman, J. E., Kelleher, K., Hoagwood, K. E., Landsverk, J., Stevens, J., et al. (2008). A survey of the infrastructure for children’s mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 84–97. doi: 10.1007/s10488-007-0147-6.PubMedCrossRefGoogle Scholar
- Sensky, T., Turkington, D., Kingdon, D., Scott, J. L., Scott, J., Siddle, R., et al. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57(2), 165–172. doi: 10.1001/archpsyc.57.2.165.PubMedCrossRefGoogle Scholar
- Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73(1), 106–115. doi: 10.1037/0022-006X.73.1.106.PubMedCrossRefGoogle Scholar
- Stetler, C., Legro, M., Rycroft-Malone, J., Bowman, C., Curran, G., Guihan, M., et al. (2006a). Role of “external facilitation” in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science, 1(1), 23–32. doi: 10.1186/1748-5908-1-23.PubMedCrossRefGoogle Scholar
- Stewart, R. E., Wiltsey Stirman, S., & Chambless, D. L. (in press). A qualitative investigation of practicing psychologists’ attitudes toward research-informed practice: Implications for dissemination strategies. Professional Psychology: Research & Practice.Google Scholar
- Stirman, S. W., Bhar, S. S., Spokas, M., Brown, G. K., Creed, T. A., Perivoliotis, D., et al. (2010). Training and consultation in evidence-based psychosocial treatments in public mental health settings: The access model. Professional Psychology: Research and Practice, 41(1), 48–56. doi: 10.1037/a0018099.CrossRefGoogle Scholar
- Turkington, D., Dudley, R., Warman, D. M., & Beck, A. T. (2006). Cognitive-behavioral therapy for schizophrenia: A review. Focus, 4(2), 223–233. Retrieved from http://psychiatryonline.org/article.aspx?articleid=50577 Google Scholar