Evidence-Based CBT for Anxiety and Depression in Children and Adolescents

A Competencies Based Approach

Elizabeth S. Sburlati, Heidi J. Lyneham, Carolyn A. Schniering, Ronald M. Rapee

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118469231
• Edition: 1
• Topic: Psychology
• Subtopic: Cognitive Behavioral Therapy (CBT)
• Index: Psychology

Evidence-Based CBT for Anxiety and Depression in Children and Adolescents

"This should be on the bookshelf of everyone treating anxious and depressed children and adolescents. A cornucopia of theory and clinical good sense alike. I will be making sure that my trainees read it cover to cover."

Dr Samantha Cartwright-Hatton, Senior Clinical Research Fellow in Psychology, University of Sussex

This is the first book to offer an explicitly competencies-based approach to the cognitive behavioral treatment of anxiety and depression in children and adolescents. Within it, an outstanding and influential set of experts in the field describe a comprehensive model of therapist competencies required for empirically supported cognitive behavioral treatment. They explore each of these competencies in great detail, and highlight effective ways of training them. As a result, the book not only supports the training, development, and assessment of competent clinicians who are implementing CBT, it is also invaluable for clinicians who wish to gain an understanding of the competencies they need to acquire or improve, and offers guidelines for how to achieve these, providing a benchmark against which they can assess themselves. Evidence-Based CBT for Anxiety and Depression in Children and Adolescents works to improve the quality of therapists working in this area, and, as a result, the quality of treatment that many young people receive.

1
An Introduction to the Competencies-Based Approach

Elizabeth S. Sburlati, Heidi J. Lyneham, and Carolyn A. Schniering

The Genesis of This Book

Empirically supported treatment, evidence-based practice, and the real world

There are a number of cognitive behavioral empirically supported treatments (ESTs) available for treating child and adolescent anxiety and depressive disorders that therapists practicing in routine clinical practice (RCP) can use when delivering evidence-based practice (EBP). However, interventions for children and adolescents may not be as effective when implemented in real world RCP settings as they are when implemented in research settings (Weisz, Ugueto, Cheron, and Herren 2013). Research is now indicating that poor real-world implementation of ESTs could be partly due to inadequate training of the therapists who work in RCP (Beidas, Barmish, and Kendall 2009; Herschell, Kolko, Baumann, and Davis 2010). As a result, there has been a call to examine and improve the quality of therapist EST training (Rakovshik and McManus 2010). However, until recently, the specific competencies that are required for the effective implementation of ESTs that target anxious and depressed children and adolescents were unknown, which made the development of more effective EST training difficult.

The competencies-based approach

The field of psychology is moving away from the traditional training approach, which focused on the trainee’s satisfying training activities (e.g., courses, client contact hours, supervision hours) to a competencies-based approach to training that aims to conceptualize, systematically train, and effectively assess the competence of trainees in performing as independent professionals (e.g., Hunsley and Barker 2011; Kaslow 2004; Kaslow et al. 2004; Knight 2011; Laidlaw and Gillanders 2011; Pachana, Sofronoff, Scott, and Helmes 2011; Roberts, Borden, Christiansen, and Lopez 2005). Competence is defined within the competencies-based approach as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served” (Epstein and Hundert 2002, p. 227). The competencies-based approach suggests that competence is comprised of competencies, which are the important component parts of competence (Kaslow 2004; Kaslow et al. 2004). According to the competencies-based approach, these competencies include a therapist’s knowledge, attitudes, and skills that are related to his or her area of practice (Kaslow 2004; Kaslow et al. 2004).

A model of therapist competencies for the evidence-based treatment of child and adolescent anxiety and depressive disorders

As a part of a large-scale initiative in the United Kingdom, the dissemination project Improving Access to Psychological Therapies (IAPT), Roth and Pilling (2008) developed a model of therapist competencies for the evidence-based cognitive behavioral treatment of adult anxiety and depression. This model was designed to be used so as to develop a training curriculum aimed at teaching therapists in RCP to implement evidence-based practice in real-world settings. Drawing on the work of Roth and Pilling (2008) and acknowledging the vast array of different competencies required when treating children and adolescents (as opposed to adults), Sburlati, Schniering, Lyneham, and Rapee (2011) developed a therapist competence model targeting the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. This model drew on all empirically supported treatment manuals that had been published prior to January 2010 and utilized the knowledge and feedback of experts from all around the world (for a complete description of the manuals, experts, and methods used in the model development, see Sburlati et al. 2011). The outcome was a model that provides a comprehensive listing of the individual competencies needed to conduct evidence-based practice with youth experiencing internalizing disorders in real-world clinical practice. The individual competencies in the model are grouped together by similarity, into competency categories, and these competency categories are placed under the three domains of competence (Sburlati et al. 2011). These three domains of competence are described below, in the part devoted to the subject. In the model, competencies were shaded gray if they were specific to the treatment of children and adolescents (but not adults) or require considerable adaptation when working with children and adolescents. (To view the model in its original format, see Sburlati et al. 2011, p. 94).

Sburlati et al. (2011) domains of competence

Generic therapeutic competencies

Generic therapeutic competencies, first identified by Roth and Pilling (2008), are those competencies that a therapist needs in order to interact with people within a therapeutic context, irrespective of therapeutic orientation. These competencies are not seen in cognitive behavioral therapy (CBT) only, but rather are used across all therapeutic models (Roth and Pilling 2008). The generic therapeutic competencies were reviewed, adapted, and expanded by Sburlati and colleagues (2011) to account for the needs of children and adolescents. The competency categories and individual competencies included in the generic therapeutic competencies domain can be seen in Table 1.1. These competencies are discussed across Chapters 3 to 7 of this book.

Table 1.1 Generic therapeutic competencies.

Source: Sburlati, Schniering, Lyneham, and Rapee (2011, p. 94).

Category	Individual competencies
Practicing professionally:	knowledge of and ability to operate within profession...