Randomized Trial of Web-Based Training to Promote Counselor Use of Cognitive Behavioral Therapy Skills in Client Sessions

ABSTRACT

Background and Methods: The authors designed and delivered an innovative Web course on cognitive behavioral therapy (CBT), a specific empirically based treatment, to a diverse group of addiction counselors and supervisors in 54 addiction units across the country, and conducted a randomized controlled trial of its effectiveness with 127 counselors. The primary focus of the trial was to assess “adequate adherence to CBT practice” after training as judged by raters blinded to training condition who listened to audiotapes of actual client sessions. Counselors who passed were judged to satisfy 2 criteria: (a) low pass or greater on at least 1 of 3 “CBT-generic skills” assessing session structure; and (b) low pass or greater on at least 1 of 3 “CBT-specific skills” related to use of functional analysis, cognitive skills practice, or behavioral skills practice. Results: Although the counselors’ use of CBT skills in sessions increased after Web course training, it was not statistically significant and not larger than the gain of control-group counselors trained with a written CBT manual.

Keywords:

• Randomized trial
• training program
• cognitive behavioral therapy
• skill improvement
• web course

Acknowledgments

Study support was received from the National Institute on Drug Abuse (R01 DA016929 and R43 DA022782-01). Throughout the study, the authors received immediate guidance and support whenever requested from their program official, Cecelia McNamara Spitznas, PhD, for which the authors are grateful. Michael Otto, PhD (Center for Anxiety and Related Disorders, Boston University), David Lewis, MD (Center for Alcohol and Addiction Studies, Brown University), and Gail S. Steketee, PhD (Boston University School of Social Work), generously commented upon and suggested improvements to the preliminary Rating Guide. Dr. Steketee also greatly assisted in content development for the full Web course and Dr. Susan Storti (Synergy Enterprises, Inc., formerly of the New England Addiction Technology Transfer Center, Brown University), was a co-investigator at the time of proposal submission and project start-up. Dr. Storti generously assisted with study recruitment. Grant Ritter, PhD, and Anne Stoddard, PhD, provided statistical advice and Carol Link, PhD, contributed greatly to the authors’ decisions on the study design and performed the random assignment of addiction units.

The authors gratefully acknowledge the substantive Web-course content contributions of the following faculty and staff who served as authors, co-authors, and expert reviewers: Stephen Braun; Julian Ford, PhD; Colleen LaBelle, RN; Lisa Najavits, PhD; Michael Otto, PhD; Mark Powers, MA, LPA; Carlota Ramirez, MA, LMHC; Thomas Salmon, PhD; Jennifer Sharpe Potter, PhD; Susan Storti, PhD; and Roger D. Weiss, MD. Finally, the authors appreciate the invaluable contributions of the counselors, supervisors, and clients at the 54 participating programs whose participation was essential to the completion of this study. Preliminary findings from this study were presented at the 2008 Addiction Health Services Research Annual Meeting, Boston, Massachusetts.