Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists

2018
Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trainedtherapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered trainingin a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered trainingin enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before trainingand after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of trainingmodules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during trainingas recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before trainingdid so after training. Compliance with trainingpredicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra trainingmodule completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during traininghad an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after trainingand the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during trainingwas associated with competence after training(OR=2.2, 95% CI 1.2-4.1). Conclusions: Independent Web-centered trainingcan successfully trainlarge numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of trainingpotentially increases the number of people who might receive effective psychological treatments. [J Med Internet Res 2018;20(6):e10386]
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