Psychotherapy Research at KCP (KCP-UF)

Behavioral Change in Clinicians

Project title: Clinician Behavior Change and Transfer of Training Following Education in Cognitive Behavior Therapy (CBT) for Professionals

Time frame: 2018-2026.

Short summary of the project: In order for clinician training to be effective, what is learnt during courses must also be implemented by participants in their respective mental health organizations. However, this transfer of training is associated with several factors affecting this process. Such variables can be found at clinician individual level, organizational level and/or at educational level. This project investigates if continuing education in CBT is associated with changes in clinician behavior directly after training and up to one year post training, and further aims to map determinants to this process at multiple levels (individual, organizational and educational). A systematic review of the literature is followed by a longitudinal survey of clinicians in CBT-training and a qualitative interview study collecting the perspective of mental health first line managers. Knowledge from these studies will then be synthesized in the development and feasibility investigation of an intervention aimed to support transfer of training, hence increasing effectiveness of clinician CBT-training.

Main research questions: Study I: Clinician behavior change following continuing education in CBT; effects and moderators. Study II: Clinician development of knowledge and skills use before and after CBT-training (plus one year follow up), and associated determinants at multiple levels. Study III: Mental health first line managers perspectives on employees’ enrollment in continuing education. Study IV: Development and feasibility of an intervention to support transfer of training.

Contact persons: tobias.lundgren@ki.se, emma.hogberg.ragnarsson@ki.se.

Development of CBT Competence

Project title: Development of Competence in Cognitive-Behavioural Therapy and the Role of Metacognition among Clinical Psychology and Psychotherapy Students.

Time frame: 2016-2020.

Short summary of the project: This longitudinal, observational study examined to what extent psychology and psychotherapy students acquired competence in CBT following extensive training, and the role of metacognition, which has been associated to learning in various non-clinical domains. We assessed CBT competence and metacognitive activity in 73 psychology and psychotherapy students before and after 1.5 years of CBT training, using role-plays with a standardised patient. We found that competence improved over time and most students performed over the threshold post-assessment. The more competent therapists tended to underrate their competence. In contrast to what has been found in other learning domains, general metacognitive ability was not associated with competence development in our study. 

Main research questions: To what extent clinical psychology and psychotherapy students acquire competence in CBT following an extensive training programme, and what role metacognition plays in the development of CBT skills

Contact persons: benjamin.bohman@ki.se, hillevi.bergvall@ki.se.

Publications related to the project

Digital Training in CBT for BDD

Project title: Supervised Digital Training of Clinicians to Assess and Deliver Cognitive Behavior Therapy for Young People with Body Dysmorphic Disorder (BDD): A Feasibility Study.

Time frame: 2022 – 2023.

Short summary of the project: The project investigate whether internet education is a feasible way to train clinicians within child and adolescent mental health services (CAMHS) in BDD. Participants are offered an online education divided in to two parts. Part 1 including training in assessing pediatric BDD and how to manage BDD patients, as well as information on evidence-based treatment (both pharmacological and psychological) for BDD. Part 2 including training in how to conduct CBT for BDD in children and adolescents. All participants will go through part 1 of the online training, and those who are expected to conduct psychological treatment at their respective clinics will also go through part 2. Each module consists of a theoretical part and a training part with assignments. During the education participants have regular contact with a supervisor that provides feedback on assignments and answer questions. During the six-months follow-up period the participants also have the ability to contact their supervisor. Participants will complete measures at baseline as well as during, post, and six months after the online education. Qualitative interviews are also conducted with the participants at post online education. 

Main research questions: The aim of this projects is to develop the online education and evaluate its feasibility (defined as whether the online education is acceptable and credible, and whether participants are satisfied and make use of the online training in their clinical practice). The study also evaluates the online education’s preliminary efficacy on improving clinicians’ knowledge and skills in assessing and treating BDD in children and adolescents, as well as clinicians’ experience of undergoing the online education.

Contact persons: markus.jansson-frojmark@ki.se; martina.gumpert@ki.se.

Evaluation of psychotherapy training

Project title: Systematic evaluation of psychotherapy training (SUP)

Time frame: 2023– 2028.

Short summary of the project: Some courses at KCP include clinical-integrated learning (VIL). VIL consists of psychotherapeutic assessment and treatment under supervision and is conducted within regular psychiatric services. The aim of SUP is to systematically evaluate selected parts of VIL.

Main research questions: The SUP project includes questions regarding the development of general and specific psychotherapy competence, quality assurance of supervision and its relation to therapist competence, quality assurance of psychotherapy and its relation to treatment outcome, as well as the effect of various supervisor and supervision variables on therapist competence, and the effect of various treatment and treatment variables on treatment outcome. Examples of included predictors and moderators: socio-demographic factors; expectations and experience of supervision/treatment, content of supervision/treatment; length of supervision/treatment; and relational and technical treatment variables.

Contact person: maria.beckman@ki.se; annika.lindgren.2@ki.se

MI Supervision and Training

Project title: Dissemination of Motivational Interviewing: The Role of Workshop Training and Subsequent Supervision in the Development of Competence in Clinical practice.

Time frame: 2014-2018.

Short summary of the project: The overall objective of the project was to evaluate various aspects of training of practitioners as part of dissemination/implementation of motivational interviewing (MI). The project included: Semi-structured interviews with ten MI-supervisors from a randomized controlled trial (RCT); one RCT with 174 MI-practitioners in five Swedish regions; one RCT with 98 of the 174 MI-practitioners; and one RCT with 134 employees from The Swedish National Board of Institutional Care (SiS).

Main research questions: The project aimed to evaluate to what extent practitioners acquire and retain skills from regular MI workshop trainings, as opposed to workshop trainings followed by supervision consisting of feedback based on monitoring of practice. The project also explored and evaluated different aspects of MI-supervision, and the correspondence between practitioners’ self-assessment and independent MI treatment integrity ratings.

Contact persons: maria.beckman@ki.se; helena.lindqvist@ki.se.

Publications related to the project

Re-thinking Clinical Supervision

Project title: Re-thinking Clinical Supervision in Psychotherapy: Psychotherapists’ clinical challenges and supervision needs, and the effects of live supervision with Bug-in-the-Ear (BITE)

Time frame: 2019 – 2027.

Short summary of the project: Clinical supervision is an essential part of psychotherapy training and development, but the empirical evidence for effects on therapist competence and patient outcome is limited. A possible explanation is that current supervision content and techniques doesn’t match the needs and challenges of the psychotherapists. Furthermore, current supervision formats don’t allow for direct observation and feedback on observable therapist behaviors from therapy sessions. Live Supervision with the method Bug-in-the-Ear (BITE) enables real time feedback during the patient session. Pilot studies of LS show promising results, but the effects have never been assessed in a clinical setting with licensed psychologists. Furthermore, manualized LS with a stringent focus at therapists’ idiosyncratic challenges has never been evaluated.

Main research questions: The overarching aim of the project is to identify what and how supervision can be performed in order to have a positive effect on therapist competence and well-being, and, in turn, patient outcome. The first two studies of this project aim at identifying central supervision needs and specific clinical challenges that can be targeted in supervision. The last two studies aim at assessing different effects and aspects of live supervision (LS), which is a supervision format that enables real time feedback during the patient session.

Contact persons: sven.alfonsson@ki.se; simon.fagernas@ki.se.