Predictors of skill trajectories in the implementation of cognitive behavioral therapy

Evidence based practices such as cognitive behavioral therapy (CBT) are often underutilized in community mental health settings. Implementation efforts can be effective in increasing CBT use among clinicians, but not all therapists successfully reach CBT competence at the end of training. Past studies have focused on how clinicians overall acquire CBT skills, rather than examining different learning trajectories that clinicians may follow and predictors of those trajectories; however, understanding of learning trajectories may suggest targets for implementation strategies.

We used growth mixture models to identity trajectories in CBT skill acquisition among clinicians (n = 812) participating in a large scale CBT training and implementation program, and examined predictors (attitudes towards EBPs, clinician burnout, professional field, educational degree level) of trajectory membership. We assessed model fit using BIC, Vuong likelihood tests, and entropy. We hypothesized that there would be at least two trajectories- one where clinicians increased in skills over time and reach CBT competence, and one with minimal increases in CBT skills that did not result in competence. We hypothesized that presence of a graduate degree, more positive attitudes towards EBPs, and lower burnout would predict more positive trajectories in CBT skill acquisition. We did not have a specific prediction for field of study and CBT skill acquisition.

Clinicians followed either a progressive trajectory with steady increases in CBT skills over time, or a stagnant trajectory with minimal increases in CBT skills. Clinicians with more positive attitudes towards EBPs were 3.51 times more likely to follow a progressive trajectory, while clinicians who were in an 'Other' professional field were 0.46 times less likely to follow a progressive trajectory. Contrary to our hypotheses, educational degree and clinician burnout did not predict CBT trajectories.

Our results indicate that attitudes towards EBPs can be an important intervention point to improve CBT skill acquisition for therapists in training and implementation efforts. More structured support for clinicians who did not receive training in mental health focused fields may also help improve CBT learning.