Developing specialist CBT supervision training in Scotland using blended learning: challenges and opportunities

How does supervision aid cognitive behaviour therapy skill development? Perspectives of CBT trainees: a thematic analysis

Eleven cognitive behaviour therapy (CBT) trainees in Scotland were interviewed regarding their experiences of clinical supervision and its impact on their skill development. Using thematic analysis, the authors developed four main themes: Linking Theory to Practice, Mirroring CBT in Supervision, The Expert Supervisor, and Trainees’ Reluctance to Give Negative Feedback. Clinical supervision was essential in helping trainees to link theory to practice; particularly through audio recordings, discussing formulations, and modelling and role-play. A CBT-specific approach to supervision and a CBT expert supervisor were also identified as valuable to learning. Trainees were reluctant to give negative feedback to supervisors, fearing negative consequences. The findings inform supervision practice.

Key learning aims

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Engagement and Usability of a Cognitive Behavioral Therapy Mobile App Compared With Web-Based Cognitive Behavioral Therapy Among College Students: Randomized Heuristic Trial

Background

Recent evidence in mobile health has demonstrated that, in some cases, apps are an effective way to improve health care delivery. Health care interventions delivered via mobile technology have demonstrated both practicality and affordability. Lately, cognitive behavioral therapy (CBT) interventions delivered over the internet have also shown a meaningful impact on patients with anxiety and depression.

Objective

Given the growing proliferation of smartphones and the trust in apps to support improved health behaviors and outcomes, we were interested in comparing a mobile app with Web-based methods for the delivery of CBT. This study aimed to compare the usability of a CBT mobile app called MoodTrainer with an evidence-based website called MoodGYM.

Methods

We used convenience sampling to recruit 30 students from a large Midwestern university and randomly assigned them to either the MoodGYM or MoodTrainer user group. The trial period ran for 2 weeks, after which the students completed a self-assessment survey based on Nielsen heuristics. Statistical analysis was performed to compare the survey results from the 2 groups. We also compared the number of modules attempted or completed and the time spent on CBT strategies.

Results

The results indicate that the MoodTrainer app received a higher usability score when compared with MoodGYM. Overall, 87% (13/15) of the participants felt that it was easy to navigate through the MoodTrainer app compared with 80% (12/15) of the MoodGYM participants. All MoodTrainer participants agreed that the app was easy to use and did not require any external assistance, whereas only 67% (10/15) had the same opinion for MoodGYM. Furthermore, 67% (10/15) of the MoodTrainer participants found that the navigation controls were easy to locate compared with 80% (12/15) of the MoodGYM participants. MoodTrainer users, on average, completed 2.5 modules compared with 1 module completed by MoodGYM users.

Conclusions

As among the first studies to directly compare the usability of a mobile app–based CBT with smartphone-specific features against a Web-based CBT, there is an opportunity for app-based CBT as, at least in our limited trial, it was more usable and engaging. The study was limited to evaluate usability only and not the clinical effectiveness of the app.

Improving CBT supervision. Four years of implementing NES Specialist Supervision Training for CBT in Scotland

NHS Education for Scotland (NES) plays a lead role in training the NHS Psychological Therapies workforce across Scotland. Ferguson et al. (2016) outlined the challenges, opportunities and proposed evaluation of the NES Specialist Supervision Training in Cognitive Behavioural Therapy (NESSST-CBT). The aims of the training were to provide an evidence-based, flexible and learner-focused training in CBT specific supervision competencies. This paper will provide an update on the evaluation of the training using Kirkpatrick’s Impact Evaluation Model (1967, 1987). Results indicate that: (1) delegates rated the training experience positively in various ways; (2) delegates described increases in their confidence and competence in using structured measures of CBT and supervision; (3) a majority of delegates completing a 3-month follow-up questionnaire described continued use of a structured CBT measure in supervision and for self-reflection; and (4) 392 psychological therapists in Scotland have now been formally trained in CBT specific supervision skills. NESSST-CBT continues to adapt and improve as a resource for staff as NES moves forward in its Digital Strategy for Scotland’s NHS and partnership staff. Further implications of this are discussed, as well as limitations of the study.

Key learning aims

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Supporting our supervisors: a Summary and Discussion of the Special Issue on CBT supervision

Contributors to this Special Issue of the Cognitive Behaviour Therapist have considered the kind of infrastructure that should be in place to best support and guide CBT supervisors, providing practical advice and extensive procedural guidance. Here we briefly summarize and discuss in turn the 10 papers within this Special Issue, including suggestions for further enhancements. The first paper, by Milne and Reiser, conceptualized this infrastructure in terms of an ‘SOS’ (supporting our supervisors) framework, from identifying supervision competencies, to training, evaluation and feedback strategies. The next nine papers illustrate this framework with specific technical innovations, educational enhancements and procedural issues, or through comprehensive quality improvement systems, all designed to support supervisors. These papers suggest an assortment of workable infrastructure developments: two large-scale and comprehensive initiatives, some promising proposals and technologies, and a series of local, exploratory work. Collectively, they provide us with models for further developing evidence-based cognitive-behavioural supervision, and offer practical suggestions for giving supervisors the tools and support to maximize their supervisees’ learning, and to improve the associated client outcomes. Much research and development work remains to be done, and successful implementation will require institutional and political support, as well as cross-cultural adaptations. We conclude with an optimistic assessment of progress toward addressing some of the infrastructure improvements required to adequately support supervisors.