Skip to main content
SpringerLink
Log in

Provision of Cognitive Behavior Therapy for Depression and Anxiety Disorders by Medical Student Trainees

  • Empirical Report
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders.

Methods

The authors assessed improvements in trainees’ CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees’ clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients’ depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire.

Results

Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning.

Conclusions

Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

The data generated in this study are available from the corresponding author upon request.

References

  1. Olfson M, Blanco C, Marcus SC. Treatment of adult depression in the United States. JAMA Intern Med. 2016;176:1482–91.

    Article  PubMed  Google Scholar 

  2. Mojtabai R, Olfson M. National trends in long-term use of antidepressant medications: results from the U.S. National Health and Nutrition Examination Survey. J Clin Psychiatry. 2014;75:169–77.

    Article  CAS  PubMed  Google Scholar 

  3. Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry. 2005;62:1097–106.

    Article  PubMed  Google Scholar 

  4. Walker ER, Cummings JR, Hockenberry JM, Druss BG. Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatr Serv. 2015;66:578–84.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Andrade LH, Alonso J, Mneimneh Z, Well JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: results from the WHO World Mental Health (WMH) surveys. Psychol Med. 2014;44:1303.

    Article  CAS  PubMed  Google Scholar 

  6. Garfield RL, Zuvekas SH, Lave JR, Donohue JM. The impact of national health care reform on adults with severe mental disorders. Am J Psychiatry. 2011;168:486–94.

    Article  PubMed  Google Scholar 

  7. Wassink JT. Out of sight and uninsured: access to healthcare among US-born minors in Mexico. J Immigr Minor Health. 2020;22:448.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Betancourt TS, Newnham EA, Birman D, Lee R, Ellis BH, Layne CM. Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. J Trauma Stress. 2017;30:209.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rowan K, McAlpine D, Blewett L. Access and cost barriers to mental health care by insurance status, 1999 to 2010. Health Aff (Millwood). 2013;32:1723.

    Article  PubMed  Google Scholar 

  10. Smith S, Thomas R, Cruz M, Griggs R, Moscato B, Ferrara A. Presence and characteristics of student-run free clinics in medical schools. JAMA. 2014;312:2407–10.

    Article  PubMed  Google Scholar 

  11. Soltani M, Smith S, Beck E, Johnson M. Universal depression screening, diagnosis, management, and outcomes at a student-run free clinic. Acad Psychiatry. 2015;39:259–66.

    Article  PubMed  Google Scholar 

  12. Rodriguez Guzman J, Ramos MA, Silva M, Mata DA, Raila H, Rohrbaugh R, et al. Training health professional students as lay counselors to treat depression in a student-run free clinic. J Student-Run Clin. 2018;4(1):1–7.

    Article  Google Scholar 

  13. Knoll O, Chakravarthy R, Cockroft JD, Baddour N, Jordan S, Weaver E, et al. Addressing patients’ mental health needs at a student-run free clinic. Community Ment Health J. 2021;57:196–202.

    Article  PubMed  Google Scholar 

  14. Stuard WL, Squiers K, Suss A, Schrader E, Triantafyllou D, Brenner A, et al. Development and implementation of psychiatric services in a student-operated clinic. Community Ment Health J. 2019;55:553–60.

    Article  PubMed  Google Scholar 

  15. Kamimura A, Gardner N, Ahmed F, Nourian MM, Myers K, Olson LM. Health status and social characteristics among the uninsured using a mental health free clinic. J Behav Health Serv Res. 2018;45:112–23.

    Article  PubMed  Google Scholar 

  16. Batra P, Chertok JS, Fisher CE, Manseau MW, Manuelli VN, Spears J. The Columbia-Harlem homeless medical partnership: a new model for learning in the service of those in medical need. J Urban Health. 2009;86:781.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Powell SK, Gibson CL, Okoroafor I, Hernandez-Antonio J, Nabel EM, Meah YS, et al. On-site prescription dispensing improves antidepressant adherence among uninsured depressed patients. Psychiatr Q. 2021;92(3):1093–107.

    Article  PubMed  Google Scholar 

  18. Powell SK, Saali A, Frere J, Magill E, Krystal H, Serafini RA, et al. Design of and outcomes in a student-run free mental health clinic serving the uninsured in East Harlem. BMC Psychiatry. 2022;22(1):501.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mann CL, Rifkin RA, Nabel EM, Thomas DC, Thomas C, Meah YS, et al. Exploring antidepressant adherence at a student-run free mental health clinic. Community Ment Health J. 2019;55:57–62.

    Article  PubMed  Google Scholar 

  20. Serafini RA, Powell SK, Frere JJ, Saali A, Krystal HL, Kumar V, et al. Psychological distress in the face of a pandemic: an observational study characterizing the impact of COVID-19 on immigrant outpatient mental health. Psychiatry Res. 2021;295:113595.

    Article  CAS  PubMed  Google Scholar 

  21. Liberman KM, Meah YS, Chow A, Tornheim J, Rolon O, Thomas DC. Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations. J Community Health. 2011;36:733–40.

    Article  PubMed  Google Scholar 

  22. Khonsari N, Davis K, Wolf D. Implementing a psychiatry clinic in a student-run setting: a medical student perspective. Acad Psychiatry. 2019;43:340–3.

    Article  PubMed  Google Scholar 

  23. Belus JM, Cohen MJ, Givens M, Smirnova N, Myerholtz L. Integrating behavioral health services in a student-run medical clinic. J Student-Run Clin. 2017;3(1):1–7.

    Article  Google Scholar 

  24. Murzl CA, Durns TA, Mowrey LT, Tubbs AS, Boeve SA. A medical student-run child and adolescent psychiatry clinic: one institution’s experience. Acad Psychiatry. 2017;41:582–6.

    Article  PubMed  Google Scholar 

  25. Zhou C, Fruitman K, Szwed S, Wickersham M, Spellun J, Zonana J. Weill Cornell Medicine Wellness Qlinic: adapting the student-run clinic model to expand mental health services and medical education. Community Ment Health J. 2022;58:1244.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bischoff T, Anderson SR, Heafner J, Tambling R. Establishment of a reliable change index for the GAD-7. Psychol Community Health. 2020;8:176–87.

    Article  Google Scholar 

  28. Wright JH, Wright AS, Salmon P, Beck AT, Kuykendall J, Goldsmith LJ, et al. Development and initial testing of a multimedia program for computer-assisted cognitive therapy. Am J Psychother. 2002;56:76–86.

    Article  PubMed  Google Scholar 

  29. Leahy RL, Holland SJF, McGinn LK. Treatment plans and interventions for depression and anxiety disorders. 2nd ed. New York: The Guilford Press; 2013.

    Google Scholar 

  30. Weck F, Kaufmann YM, Höfling V. Competence feedback improves CBT competence in trainee therapists: a randomized controlled pilot study. Psychother Res. 2017;27(4):501–9.

    Article  PubMed  Google Scholar 

  31. Bennett-Levy J, McManus F, Westling BE, Fennell M. Acquiring and refining CBT skills and competencies: which training methods are perceived to be most effective? Behav Cogn Psychother. 2009;37:571–83.

    Article  PubMed  Google Scholar 

  32. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    Article  PubMed  Google Scholar 

  33. Mair P, Wilcox R. Robust statistical methods in R using the WRS2 package. Behav Res Methods. 2020;52:464–88.

    Article  PubMed  Google Scholar 

  34. Shah S. How should academic medical centers administer students’ “domestic Global Health” experiences? AMA J Ethics. 2019;21:778–87.

    Article  Google Scholar 

  35. Young JE, Beck AT. Cognitive therapy scale rating manual. Bala Cynwyd, PA: Beck Institute for Cognitive Therapy; 1980. https://beckinstitute.org/wp-content/uploads/2021/06/CTRS-Manual-2020.pdf. Accessed 15 Sept 2023.

  36. Givens JL, Houston TK, van Voorhees BW, Ford DE, Cooper LA. Ethnicity and preferences for depression treatment. Gen Hosp Psychiatry. 2007;29:182–91.

    Article  PubMed  Google Scholar 

  37. Schweitzer PJ, Rice TR. The student-run clinic: a new opportunity for psychiatric education. Acad Psychiatry. 2012;36:233–6.

    Article  PubMed  Google Scholar 

  38. Mishan LI, Dragatsi D. Student-run clinics: a novel approach to integrated care, teaching and recruitment. Community Ment Health J. 2017;53:460–3.

    Article  PubMed  Google Scholar 

  39. Fischbein R, Gardner-Buckshaw S, Loucek A, Ravichandran S, Eicher M, Boltri JM. Pandemic productivity: student-run free clinic integrates behavioral health in the wake of COVID-19. Acad Psychiatry. 2021;45:608–12.

    Article  PubMed  Google Scholar 

  40. Aboul-Fotouh F, Asghar-Ali AA. Therapy 101: a psychotherapy curriculum for medical students. Acad Psychiatry. 2010;34(4):248–52.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to acknowledge the patients who participated in this research study. We also wish to acknowledge Gary Katzman, M.D., Gwilym Rodick, LCSW, Michael Devlin, M.D., Kenneth Carpenter, Ph.D., Beth Brodsky, Ph.D., and Eun-Jung Suh, Ph.D. for their important contributions as lecturers in the EHHOP CBT Program.

Author information

Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Samuel K. Powell, Randal A. Serafini, Justin J. Frere, Agathe De Pins, Alexandra Saali, Syeda A. Sultana, Muhammad Ali, Brandon Dale, Debjyoti Datta, Cindy Aaronson, Yasmin Meah, Craig L. Katz & Vicki Gluhoski

Authors
  1. Samuel K. Powell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Randal A. Serafini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin J. Frere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agathe De Pins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandra Saali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Syeda A. Sultana
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Muhammad Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brandon Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Debjyoti Datta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cindy Aaronson
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yasmin Meah
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Craig L. Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Vicki Gluhoski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel K. Powell.

Ethics declarations

Disclosures

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Powell, S.K., Serafini, R.A., Frere, J.J. et al. Provision of Cognitive Behavior Therapy for Depression and Anxiety Disorders by Medical Student Trainees. Acad Psychiatry 48, 10–17 (2024). https://doi.org/10.1007/s40596-023-01873-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40596-023-01873-8

Keywords

Search

Navigation