Training and dissemination of cognitive behavior therapy for depression in adults: a preliminary examination of therapist competence and client outcomes.

OBJECTIVE In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. METHOD Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). RESULTS Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p < .001. The CBT clients also showed a significant decrease in anxiety symptoms, whereas the TAU clients did not. CONCLUSIONS Although there remains a significant amount to learn to guide researchers' mission of improving the availability and effectiveness of treatment for individuals with depression, this study demonstrates that an empirically supported treatment can be implemented in a community mental health center and may result in improved outcomes.