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My Therapist is a Student? The Impact of Therapist Experience and Client Severity on Cognitive Behavioural Therapy Outcomes for People with Anxiety Disorders

Published online by Cambridge University Press:  20 February 2015

Liam Mason ,
Nick Grey  and
David Veale Open the ORCID record for David Veale [Opens in a new window]
Liam Mason*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
Nick Grey
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, and South London and Maudsley NHS Foundation Trust, UK
David Veale
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, and South London and Maudsley NHS Foundation Trust, UK
*
Reprint requests to Liam Mason, Department of Clinical Psychology, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK. E-mail: liam.mason@kcl.ac.uk
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Abstract

Background: Allocation of trainee therapist cases is often performed based on intuition and clinical circumstances, with lack of empirical evidence on the role of severity of presenting problem. This has the potential to be anxiety-provoking for supervisors, trainees and service users themselves. Aims: To determine how therapist experience interacts with symptom severity in predicting client outcomes. Method: An intention-to-treat analysis of annual outcome data for primary and secondary care clients seen by a specialist anxiety disorders service. 196 clients were stratified into mild, moderate and baseline severe symptoms of anxiety (GAD-7) and depression (PHQ-9). We measured percentage change on these measures, as well as number of sessions and therapy dropout. We also examined rates of reliable and clinically significant change on disorder-specific measures. We hypothesized that qualified therapists would achieve better outcomes than trainees, particularly for severe presentations. Results: Overall, outcomes were comparable between trainee and qualified therapists on all measures, and trainees additionally utilized fewer therapy sessions. There was however an interaction between anxiety severity (GAD-7) and therapist group, such that severely anxious clients achieved greater symptom improvement with qualified as compared to trainee therapists. Further, for trainee but not qualified therapists, baseline anxiety was negatively associated with rate of reliable and clinically significant change on disorder-specific measures. Conclusions: These findings indicate generally favourable outcomes for trainee therapists delivering manualized treatments for anxiety disorders. They additionally suggest that trainee therapists may benefit from additional support when working with clients that present with severe anxiety.

Keywords

PsychologicaltherapistCBTtraineeoutcomeanxiety
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 2 , March 2016 , pp. 193 - 202
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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References

Beutler, L. E. (2004). The empirically supported treatments movement: a scientist-practitioner's response. Clinical Psychology: Science and Practice, 11, 225–229.Google Scholar
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44.CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.Google Scholar
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. Social Phobia: Diagnosis, Assessment, and Treatment, 41, 22–23.Google Scholar
Clark, M. (2011). Mental health care clusters and payment by results: considerations for social inclusion and recovery. Mental Health and Social Inclusion, 15, 71–77.CrossRefGoogle Scholar
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H. and Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN) New self-rating scale. The British Journal of Psychiatry, 176, 379–386.Google Scholar
Creamer, M., Bell, R. and Failla, S. (2003). Psychometric properties of the impact of event scale-revised. Behaviour Research and Therapy, 41, 1489–1496.Google Scholar
Department of Health (2011). The IAPT Data Handbook 2. London: DoH.Google Scholar
Eells, T. D., Lombart, K. G., Kendjelic, E. M., Turner, L. C. and Lucas, C. P. (2005). The quality of psychotherapy case formulations: a comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. Journal of Consulting and Clinical Psychology, 73, 579.Google Scholar
Ehlers, A. and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.Google Scholar
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive–compulsive disorder scale: the Obsessive–Compulsive Inventory. Psychological Assessment, 10, 206.Google Scholar
Ginzburg, D. M., Bohn, C., Höfling, V., Weck, F., Clark, D. M. and Stangier, U. (2012). Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder. Behaviour Research and Therapy, 50, 747–752.CrossRefGoogle ScholarPubMed
Hofmann, S. G. and Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69, 621.Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12.Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The Phq-9. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., et al. (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care, 46, 266–274.CrossRefGoogle ScholarPubMed
Mendlowicz, M. V. and Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157, 669–682.Google Scholar
Mueser, K. T., Silverstein, S. M. and Farkas, M. D. (2013). Should the training of clinical psychologists require competence in the treatment and rehabilitation of individuals with a serious mental illness? Psychiatric Rehabilitation Journal, 36, 54.Google Scholar
National Institute for Clinical Excellence (2004). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalized anxiety disorder) in adults in primary, secondary and community care. London: NICE.Google Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Schulte, D. and Eifert, G. H. (2002). What to do when manuals fail? The dual model of psychotherapy. Clinical Psychology: Science and Practice, 9, 312–328.Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097.Google Scholar
Vollmer, S., Spada, H., Caspar, F. and Burri, S. (2013). Expertise in clinical psychology: the effects of university training and practical experience on expertise in clinical psychology. Frontiers in Psychology, 4, 141.Google Scholar
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47, 119–127.CrossRefGoogle ScholarPubMed
Witteman, C. L. and van den Bercken, J. H. (2007). Intermediate effects in psychodiagnostic classification. European Journal of Psychological Assessment, 23, 56–61.Google Scholar
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