The role of implementation organizations in scaling evidence-based psychosocial interventions.

BACKGROUND: To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. MAIN BODY: We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. CONCLUSION: We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.

Effects of cognitive therapy for depression on daily stress-related variables.

This study used a daily diary design to evaluate depressed patients' changes on daily stress-related variables during cognitive therapy (CT). Patients completed daily diaries on two week-long occasions: after the intake interview and again after the sixth session of CT. Patients also completed a measure of depressive symptoms before every treatment session. After six sessions of CT, patients reported a significant reduction in: (a) depressive symptoms; (b) daily sad affect (SA); (c) daily negative thoughts associated with the day's most stressful event; and (d) SA reactivity to daily stressors. In addition, patients reported a significant increase in: (e) daily positive affect (PA); and (f) SA reactivity to daily negative thoughts. The results suggest that CT has its intended effects on the daily lives of depressed adults, and highlight the value of a daily diary methodology for research on CT.

Negative affective spillover from daily events predicts early response to cognitive therapy for depression.

This study evaluated the predictive role of depressed outpatients' (N = 62) affective reactivity to daily stressors in their rates of improvement in cognitive therapy (CT). For 1 week before treatment, patients completed nightly electronic diaries that assessed daily stressors and negative affect (NA). The authors used multilevel modeling to compute each patient's within-day relationship between daily stressors and daily NA (within-day reactivity), as well as the relationship between daily stressors and next-day NA (next-day reactivity; affective spillover). In growth model analyses, the authors evaluated the predictive role of patients' NA reactivity in their early (Sessions 1-4) and late (Sessions 5-12) response to CT. Within-day NA reactivity did not predict early or late response to CT. However, next-day reactivity predicted early response to CT, such that patients who had greater NA spillover in response to negative events had a slower rate of symptom change during the first 4 sessions. Affective spillover did not influence later response to CT. The findings suggest that depressed patients who have difficulty bouncing back the next day from their NA reactions to a relative increase in daily negative events will respond less quickly to the early sessions of CT.

Cognitive behavioral therapy: a blueprint for attaining and assessing psychiatry resident competency.

BACKGROUND: The Residency Review Committee (RRC) for Psychiatry of the Accreditation Council on Graduate Medical Education (ACGME) now requires that all psychiatric residency programs demonstrate competency for all psychiatric residents in cognitive behavior therapy (CBT). OBJECTIVE: To increase awareness about specific knowledge, skills, and attitudes necessary to perform competent CBT, optimal teaching methods available to insure competency, and valid assessment tools and resources available to training programs. METHODS: Literature review and discussion of common features of successful training programs. RESULTS AND CONCLUSIONS: Training programs have resources and standardized methods of training, supervision, and assessment available to help residents meet the ACGME mandated competency requirements in CBT.

Readiness of psychiatry residency training programs to meet the ACGME requirements in cognitive-behavioral therapy.

The authors assessed the readiness of adult psychiatry residency programs to train residents in cognitive-behavioral therapy (CBT) prior to the January 2001 revision of program requirements by the Accreditation Council for Graduate Medical Education (ACGME). Adult residency training program directors were surveyed. Data analysis evaluated relationships between directors' confidence in CBT training and the program and faculty characteristics. Responses were received from 54.2% of programs. Half had no requirement for resident-performed CBT. Directors' confidence in CBT training was significantly related to didactic hours (P=0.041), psychotherapy hours (P=0.007), and ACT-certified faculty (P=0.035). A substantial lack of required training in CBT exists in least 25% of accredited programs. Assessing faculty credentials and working with specialty organizations recommended in this article could assist in developing better programs in CBT.