Skip to main content

Advertisement

Log in

Feasibility of Dissemination of Cognitive Behavioral Therapy to Texas Community Mental Health Centers

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

State mental health systems are actively seeking to disseminate empirically supported treatment approaches to improve the outcomes of adults with serious mental illnesses. However, many of these interventions have not been studied within public mental health settings. Cognitive behavioral therapy (CBT) has been shown to be effective for major depression in well-controlled trials, but its effectiveness in public mental health settings is less known. The present study examines the feasibility of dissemination of CBT in the Texas public mental health system. Seven clinicians were trained by a CBT expert and supervised for 5 months, during which time their skills approached competency levels of therapists in randomized controlled trials. Forty clients were treated during the therapists’ training phase, attending an average of ten sessions and experiencing a significant reduction in depressive symptoms. Study results are compared with previously published studies of CBT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. DeRubeis RJ, Gelfand LA, Tang TZ, et al. Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry 1999;156:1007–1013.

    CAS  PubMed  Google Scholar 

  2. Dobson KS. A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology 1989;57:414–419.

    Article  CAS  PubMed  Google Scholar 

  3. Gloaguen V, Cottraux J, Cucherat M, et al. A meta-analysis of the effects of cognitive therapy in depressed clients. Journal of Affective Disorders 1998;49:59–72.

    Article  CAS  PubMed  Google Scholar 

  4. Jarrett RB, Basco MR, Risser R, et al. Is there a role for continuation phase cognitive therapy for depressed outpatients? Journal of Consulting and Clinical Psychology 1998;66:1036–1040.

    Article  CAS  PubMed  Google Scholar 

  5. Jarrett RB, Eaves GG, Grannemann BD, et al. Clinical, cognitive and demographic predictors of response to cognitive therapy for depression: A preliminary report. Psychiatry Research 1991;37:245–260.

    Article  CAS  PubMed  Google Scholar 

  6. Robinson LA, Berman JAS, Neimeyer RA. Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin 1990;108:30–49.

    Article  CAS  PubMed  Google Scholar 

  7. Sotsky SM, Glass DR, Shea MT, et al. Patient predictors of response to psychotherapy and pharmacotherapy: Findings in the NIMH Treatment of Depression Collaborative Research Program. American Journal of Psychiatry 1991;148:997–1008.

    CAS  PubMed  Google Scholar 

  8. Thase ME, Reynolds CF, Frank E, et al. Response to cognitive-behavioral therapy in chronic depression. Journal of Psychotherapy Practice and Research 1994;3:204–214.

    Google Scholar 

  9. Zlotnick C, Elkin I, Shea MT. Does the gender of a client or the gender of the therapist affect the treatment of clients with major depression? Journal of Consulting and Clinical Psychology 1998;66:655–659.

    Article  CAS  PubMed  Google Scholar 

  10. Scott J, Teasdale JD, Paykel ES, et al. Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. British Journal of Psychiatry 2000;177:440–446.

    Article  CAS  PubMed  Google Scholar 

  11. Bockting CLH, Schene AH, Spinhoven P, et al. Preventing relapse/recurrence in recurrent depression with cognitive therapy: A randomized controlled trial. Journal of Consulting and Clinical Psychology 2005;73:647–657.

    Article  PubMed  Google Scholar 

  12. Fava GA, Rafanelli C, Grandi S, et al. Prevention of recurrent depression with cognitive behavioral therapy: Preliminary findings. Archives of General Psychiatry 1998;55:816–820.

    Article  CAS  PubMed  Google Scholar 

  13. Teasdale JD, Segal ZV, Williams JMG, et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology 2000;68:615–623.

    Article  CAS  PubMed  Google Scholar 

  14. Vittengl JR, Clark LA, Dunn TW, et al. Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy’s effects. Journal of Consulting and Clinical Psychology 2007;75:475–488.

    Article  PubMed  Google Scholar 

  15. Nemeroff CB, Heim CM, Thase ME, et al. Differential responses to psychotherapy versus pharmacotherapy in clients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the USA 2003;100:14293–14296.

    Article  CAS  PubMed  Google Scholar 

  16. 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;164:739–752.

    Article  PubMed  Google Scholar 

  17. American Psychiatric Association. Practice guideline for the treatment of clients with major depressive disorder (2nd ed.). American Journal of Psychiatry 2000;157(April suppl.):1–45.

    Google Scholar 

  18. U.S. Agency for Health Care Policy and Research. Depression in primary care: Detection, diagnosis and treatment, vols. 1 and 2. Rockville, Maryland: Author, 1993.

    Google Scholar 

  19. Merrill KA, Tolbert VE, Wade WA. Effectiveness of Cognitive Therapy for depression in a community mental health center: A benchmarking study. Journal of Consulting and Clinical Psychology 2003;71:404–409.

    Article  PubMed  Google Scholar 

  20. Tuschen-Caffier B, Pook M, Frank M. Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting. Behaviour Research and Therapy 2001;39:299–308.

    Article  CAS  PubMed  Google Scholar 

  21. Wade WA, Treat TA, Stuart GL. Transporting an empirically supported treatment for panic disorder to a service clinic setting: A benchmarking strategy. Journal of Consulting and Clinical Psychology 1998;66:231–239.

    Article  CAS  PubMed  Google Scholar 

  22. Morrison AP, Renton JC, Williams S, et al. Delivering cognitive therapy to people with psychosis in a community mental health setting: An effectiveness study. Acta Psychiatrica Scandinavia 2004;110:36–44.

    Article  CAS  Google Scholar 

  23. Addis ME, Hatgis C, Krasnow AD, et al. Effectiveness of cognitive behavioral treatment for panic disorder versus treatment as usual in a managed care setting. Journal of Consulting and Clinical Psychology 2004;72:625–635.

    Article  PubMed  Google Scholar 

  24. Foa EB, Hembree EA, Feeny NC, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology 2005;73:953–964.

    Article  PubMed  Google Scholar 

  25. Basco MR, Bostic JQ, Davies D, et al. Methods to improve diagnostic accuracy in a community mental health setting. American Journal of Psychiatry 2000;157:1599–1605.

    Article  Google Scholar 

  26. Trivedi MJ, Rush AJ, Crismon ML, et al. Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Archives of General Psychiatry 2004;61:669–680.

    Article  PubMed  Google Scholar 

  27. Rush AJ, Trivedi MH, Carmody TJ, et al. One-year clinical outcomes of depressed public sector outpatients: A benchmark for subsequent studies. Biological Psychiatry 2004;56:46–53.

    Article  PubMed  Google Scholar 

  28. Southam-Gerow MA, Austin AA, Marder AM. Transportability and dissemination of psychological treatments: Research models and methods. In: McKay D, ed. Handbook of research methods in abnormal and clinical psychology. Newbury Park, CA: Sage, 2008:203–224.

    Google Scholar 

  29. Rush AJ, Giles DE, Schlesser MA, et al. The Inventory for Depressive Symptomatology (IDS): Preliminary findings. Psychiatry Research 1986;18:65–87.

    Article  CAS  PubMed  Google Scholar 

  30. Rush AJ, Gullion CM, Basco MR, et al. The Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological Medicine 1996;26:477–486.

    Article  CAS  PubMed  Google Scholar 

  31. Wright JH, Wright AS, Albano AM, et al. Computer-assisted cognitive therapy for depression: Maintaining efficacy while reducing therapist time. American Journal of Psychiatry 2005;162:1158–1164.

    Article  PubMed  Google Scholar 

  32. Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in clients with chronic major depression. Biological Psychiatry 2003;54:573–583.

    Article  PubMed  Google Scholar 

  33. Beck AT, Rush AJ, Shaw B, et al. Cognitive Therapy of Depression. New York: Guilford Press, 1979.

    Google Scholar 

  34. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review 1988;8:77–100.

    Article  Google Scholar 

  35. Young JE, Beck AT. Cognitive Therapy Scale Rating Manual. Unpublished manuscript. University of Pennsylvania, Philadelphia, PA, 1980.

    Google Scholar 

  36. Vallis TM, Shaw BF, Dobson KS. The Cognitive Therapy Scale: Psychometric properties. Journal of Consulting and Clinical Psychology 1986;54:381–385.

    Article  CAS  PubMed  Google Scholar 

  37. Shaw BF, Elkin I, Yamaguchi J, et al. Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression. Journal of Consulting and Clinical Psychology 1999;67:837–846.

    Article  CAS  PubMed  Google Scholar 

  38. Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin 1979;86:420–428.

    Article  CAS  PubMed  Google Scholar 

  39. Dunlop WP, Cortina JM, Vaslow JB, et al. Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods 1996;1:170–177.

    Article  Google Scholar 

  40. Cohen J. Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Earlbaum Associates, 1988.

    Google Scholar 

  41. Friedman ES, Thase ME, Kornblith SJ, et al. The implementation of cognitive therapy in STAR*D. Cognitive Therapy and Research 2004;28:819–833.

    Article  Google Scholar 

  42. Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice 2002;9:329–343.

    Article  Google Scholar 

  43. Bastien CH, Morin CM, Ouellet M-C, et al. Cognitive behavioral treatment for insomnia: Comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology 2004;72:653–659.

    Article  PubMed  Google Scholar 

  44. Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression. Archives of General Psychiatry 2005;62:1007–1014.

    Article  PubMed  Google Scholar 

  45. Simons AD, Garfield SL, Murphy GE. The process of change in cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry 1984;41:45–51.

    CAS  PubMed  Google Scholar 

  46. Barber JP, DeRubeis RJ. Change in compensatory skills in cognitive therapy for depression. Journal of Psychotherapy Practice and Research 2001;10:8–13.

    CAS  PubMed  Google Scholar 

  47. Blackburn IM, Moore RG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-clients with recurrent depression. British Journal of Psychiatry 1997;171:328–334.

    Article  CAS  PubMed  Google Scholar 

  48. Jacobson NS, Dobson KS, Truax PA, et al. A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology 1996;64:295–304.

    Article  CAS  PubMed  Google Scholar 

  49. Elkin I, Shea MT, Watkins JH, et al. NIMH treatment of depression collaborative research program; I: general effectiveness of treatments. Archives of General Psychiatry 1989;46:971–982.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by grant 1 R24 MH068705-01 from the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration. We would like to acknowledge the contributions and support of patients, therapists, administrators, and staff at the Department of State Health Services and at all participating study sites, which include Mental Health Mental Retardation of Tarrant County, Texas Panhandle MHMR, Lubbock Regional Mental Health Mental Retardation Center, and Hill Country Community MHMR Center. We would also like to thank Dr. Marcia Toprac, Dr. A. John Rush and Ms. Katherine Voges for their contributions to this research project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Molly A. Lopez PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lopez, M.A., Basco, M.R. Feasibility of Dissemination of Cognitive Behavioral Therapy to Texas Community Mental Health Centers. J Behav Health Serv Res 38, 91–104 (2011). https://doi.org/10.1007/s11414-009-9209-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-009-9209-8

Keywords

Navigation