Cognitive behavioral therapy for psychosis – training practices and dissemination in the United States

Abstract

Objective: Cognitive-Behavioral Therapy for psychosis (CBTp) is an evidence-based treatment for psychosis-related disorders. However, despite the strong evidence-base and inclusion in national treatment guidelines, CBTp remains poorly disseminated in the US. It is proposed that this state is a product of lack of CBTp knowledge among clinical training leaders along with limited availability of training opportunities.

Method: We surveyed training directors in US psychiatry residency and clinical psychology doctoral programs to characterize the penetration of CBTp training and to assess their familiarity with basic CBTp facts.

Results: Directors displayed limited knowledge of CBTp effectiveness, with only 50% of psychiatry and 40% of psychology directors believing that CBTp is efficacious. Only 10% of psychiatry and 30% of psychology directors were aware that the CBTp evidence-base is based on meta-analyses. While 45% of all directors reported that their program offer CBTp training, trainees received limited training – 4 hours of didactics, 21 hours of treatment, and 12 hours of supervision.

Conclusions: CBTp dissemination in the US is characterized by training directors' minimal awareness of the CBTp evidence-base along with training opportunities that are so limited as to be unlikely to be adequate to provide CBTp effectively, hence unlikely to improve patients' psychoses.

Keywords:

• schizophrenia
• psychosis
• CBT training
• training directors
• psychiatry
• clinical psychology
• residents
• graduate students
• survey

Notes

1. Disclosure: The primary author (DK) is a training faculty at The Institute of Cognitive Therapy for Psychosis (ICTP), a post-graduate CBTp training program located in New York City.