1. Towards competence-based CBT workshops ERNST H.W. KOSTER GHENT UNIVERSITY 12/09/2014

2. Recurrent depression  Increasing interest in training competence in CBT  Empirical data suggesting that therapist competence in delivering CBT is associated with the outcome of CBT (e.g., Ginzburg et al., 2012).  Only limited focus on competence is CBT workshops  Little attention to the individual starting knowledge  Workshops focused on information transmission  No assessment of competence after training

3. The idea and design  Pilot study on Modifying workshops to include: (1) Competence-based learning objectives (2) A more specified focus on skill-acquisition during the workshops (3) A brief assessment of competence after the workshop  Pilot: Workshop on exposure  Key element in many of our treatments  Existing ideas on what constitutes competent exposure (Centre of outcome research and effectiveness)  Two different workshop dates

4. The idea and design  Together with the trainer the content of the workshop was adjusted based on the different criteria of competence  Participants were administered a questionnaire about their exposure skills pre-workshop in order to be able to adjust the content  8 week follow-up we re-administered the questionnaire on competence online  Offered therapist the possibility to record an exposure session to receive feedback (taking into account confidentiality/ technical issues, etc)

5. The idea and design  Exposure competence ratings over time (Likert scale 1 – 7; n = 6) ItemBaselineFollow-up MSDM Theory / Explanation 5.500.846.000.63 Hierarchy of fear 5.330.826.170.75 Collaboration (in terms of structure of exposure and avoidance behavior) 4.831.175.671.03 Implementation of in vitro and in vivo exposure 4.671.515.670.52 Resources 4.831.175.671.03 Transition to client-guided exposure 4.831.475.831.17 Evaluation 4.831.176.000.89 Transfer of skills 4.671.035.831.17 Total score 39.508.6946.836.59

6. The data  Despite reminders none of the therapist recorded an exposure session! Why?  Time investment (but…)  Technical difficulties  Doubts and worries  No incentive (well…)  …

7. Final thoughts  Interesting pilot  Diagnostic value: Readiness to Focus on Competence  Barriers for implementation Future:  Change current mentality in Therapists (bottom-up)  Try to get Mental Health Centers on board (top-down)  Make competence based assessment compulsory within workshops  Basically:

9. Costs  Amount awarded: 3000 euro  Positive balance of 2400 euro  Project extension Type of costAmount Trainer investment500 euro Expenses (travel)100 euro

10. A CKNOWLEDGEMENT : Ghent University: - Kristof Hoorelbeke Psychopathology and Affective Neuroscience Lab www.pan.ugent.be Contact: Ernst.Koster@UGent.be Peter van den Bilcke & VVGT EABCT!!