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The Relationship between Competence and Patient Outcome with Low-Intensity Cognitive Behavioural Interventions

Published online by Cambridge University Press:  14 September 2017

Amanda Branson ,
Pamela Myles ,
Mishka Mahdi  and
Roz Shafran
Amanda Branson*
Affiliation:
School of Psychology and CLS, University of Reading, Earley Gate, Reading
Pamela Myles
Affiliation:
School of Psychology and CLS, University of Reading, Earley Gate, Reading
Mishka Mahdi
Affiliation:
University College London Great Ormond Street Institute of Child Health, Gower Street, London
Roz Shafran
Affiliation:
University College London Great Ormond Street Institute of Child Health, Gower Street, London
*
Correspondence to Amanda Branson, University of Reading, Earley Gate, Reading RG6 6AL, United Kingdom. E-mail: a.branson@reading.ac.uk
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Abstract

Background: Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions. Aims: The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative. Method: Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients’ symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up. Results: Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs. Conclusion: Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.

Keywords

IAPTtrainingdepressionanxietylow-intensityPWPpsychological well-being practitioner
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 1 , January 2018 , pp. 101 - 114
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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