Cognitive-behavioural therapy training for junior psychiatric trainees

There is an identified need for more psychiatrists who have been trained in cognitive-behavioural therapy (CBT). The Royal College of Psychiatrists9 guidelines for psychotherapy training recommend that all psychiatric trainees receive CBT training. This paper describes a brief programme of CBT training for psychiatric senior house officers (SHO) which demonstrates a viable model achieving limited training objectives.


The study
The Northumberland SHO rotation is an eight slot scheme which has approval for 18 months of general professional training. The rotation is based at St George's Hospital in Morpeth and has three placements at the Faimlngton Centre in Hexham which is over 30 miles away. As part of introductory teaching in the psychotherapies, trainees receive CBT training under consultant supervision while they are based at the Fairnington Centre.
The CBT training takes the form of a weekly one and a half hour meeting with the consultant supervisor. The first six sessions are semistructured seminars which introduce the trai nees to the cognitive model and the therapeutic approaches used in CBT. A number of difierent teaching methods are used including didactic teaching, inductive learning and experiential learning through, for example, role playing. The aim of the teaching style is to attempt to emulate as far as possible the inductive educational approach used in CBT. After the six introductory seminars the trainees are allocated cases for brief CBT which have been screened by the consultant supervisor. The cases are predomi nantly patients with uncomplicated major de pressive episodes of moderate severity or patients with anxiety disorders (panic disorder, social phobia and generalised anxiety disorder). The style of case supervision also attempts to reflect the cognitive therapeutic style in that supervision sessions are structured and problem focused.
In September 1995, the first eight trainee psychiatrists who had participated in the CBT teaching were contacted by letter by one of the authors (JO) and asked to complete anon ymously a questionnaire.
The questionnaire included six items asking trainees to indicate on Likert scales the usefulness of the CBT training in improving clinical practice and knowledge. They were also asked to indicate how many patients they had seen as part of the CBT training and to complete a clinical global impressions (global improvement) scale (CGI; Guy, 1976) for each of the patients they had seen.

Findings
Seven out of the eight trainees were successfully contacted and returned the questionnaire. The eighth trainee could not be contacted. All seven respondents rated their knowledge of cognitivebehavioural principles as having increased sig nificantly, and they were significantly more aware of the indications for CBT. One trainee reported minimal improvement in the practice of CBT, but the remaining six reported significant improvement in their skills. The number of patients seen by the trainees for cognitive behaviour therapy varied; one trainee saw three patients, two trainees saw two patients and the remaining four trainees saw one patient. None of the patients deteriorated during the CBT, one did not change, three improved minimally, six improved significantly and one improved greatly, according to the trainees' ratings.
All the respondents indicated that overall the CBT training programme had been helpful or very helpful.

Discussion
The trainees and their patients appeared to benefit from the CBT training programme. The trainees also became significantly more knowl edgeable about the use of CBT. The findings of this study indicate that it is feasible for a small junior psychiatric rotation to establish a viable programme of training in CBT. The success of the programme in Northumberland has been depen dent on the availability of an interested consul tant. Other districts may find that a viable programme would need to rely on the availability of non-psychiatric cognitive-behavioural thera pists (Duncan-Grant & Cornish, 1995).
One of the aims of the programme was to satisfy the College's recommendation that junior trainees see two brief cases during CBT training. All the trainees in this programme saw at least one case but only three out of the seven were able to meet the recommendation. None of the trainees were able to see a long-term CBT case. In order to fully meet the College's recommenda tions it will be necessary for trainees to have a longer-term attachment to a cognitive therapy supervisor. This will have implications in terms of protecting the time of both trainees and supervisor.
A number of trainees who participated in this programme were new entrants to psychiatry and had no previous training in the psychotherapies. Some of the trainees commented that through the CBT seminars they were able to gain some insight into interpersonal processes in their work place. This is an area which in the early part of psychiatric training is usually discussed within Balint-type groups. Cognitive-behavioural semi nar groups may therefore fulfil some of the functions which have in the past been the domain of dynamically orientated seminar groups.