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North American Policies that Support
CBTp Delivery
Policy
In 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a one-day expert panel meeting in which mental health administrators, experts in CBTp, and people with lived experience from across the U.S. and Canada examined the key areas of need for redressing the inaccessibility of CBT for psychosis. As a product of this meeting, two documents addressing the importance of the routine availability of Cognitive Behavioral Therapy for psychosis (CBTp) in the United States were issued:
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The first is a CBTp implementation guide published in May 2021 by SAMHSA. This document represents the first federally-issued declaration that CBTp should be offered as the standard of care in behavioral health settings, and that CBTp-informed care, at a minimum, should be offered to individuals with psychotic disorders across forensic, correctional, primary care, and educational settings.
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The second, more extensive document - The Position Statement on the Routine Administration of Cognitive Behavioral Therapy for Psychosis as the Standard of Care for Individuals Seeking Treatment for Psychosis – is intended to supplement the SAMHSA guide. Published by the National Association of State Mental Health Program Directors, the position statement details a rationale for sustainable CBTp implementation and delivers key recommendations to support broad intra- and inter-organizational adoption for individuals who have or are at risk of developing a psychotic disorder.
Policy
CBTp Websites
Website
Handouts
COVID-19 Articles and Resources
Journal Article:
Adapting CBTp During the Pandemic
In response to the pressing need to flexibly deliver high-quality care to individuals with psychosis during the COVID-19 pandemic, Drs. Sarah Kopelovich and Doug Turkington propose high-yield cognitive behavioral techniques for psychosis (HY-CBt-p) facilitated by task sharing and digital enhancements. Previous research suggests that effect sizes will be lower than that of 16-session formulation-driven CBTp, but additional research is needed to test the feasibility, acceptability, efficacy, and comparative effectiveness of different forms of remote-delivered CBTp.
Clinical Tip Sheet:
Supporting CBT Clients
During COVID-19
(Part 2 of 2)
Part 2 of this 2-part clinical tip sheet shares key intervention targets and strategies to consider in the remote or hybrid delivery of CBTp. Access to the recorded didactics that are intended to accompany these materials are also available by request by emailing cbtECHO@uw.edu.
Cultural Considerations when Applying CBT to Racial and Ethnic Minorities
This practice brief, prepared by Drs. Jessica Maura and Sarah Kopelovich for the Northwest Mental Health Technology Transfer Center, is intended to help clinicians enhance their cultural awareness and incorporate culturally-relevant practices into a cognitive behavioral formulation and treatment approach.
Best and Promising Practices Fact Sheet: Cognitive Behavioral Therapy for Psychosis (CBTp)
This fact sheet, prepared by Sarah Kopelovich for the Northwest Mental Health Technology Transfer Center, provides an overview of the principles and practices of Cognitive Behavioral Therapy for Psychosis (CBTp). It was designed to provide the mental health workforce with information about a wide array of evidence-based and promising approaches.
The Importance of Human Relationships, Ethics and Recovery-Oriented Values
This research brief, prepared by Drs. Jessica Maura and Sarah Kopelovich for the Northwest Mental Health Technology Transfer Center, captures the methodology and key findings of a review paper published by Drs. Alison Brabban , Rory Byrne, Eleanor Longden, and Anthony Morrison on service user perceptions of CBTp. The brief includes the top 10 strategies to ensure ethical and competent delivery of CBTp.
Cognitive and behavioural therapy (CBT) for people with depression and anxiety: What skills can service users expect their therapists to have?
This fact sheet, prepared by Anthony D. Roth and Stephen Pilling for the Department of Health, describes CBT and outlines what the intervention may look like for service users, including what a good CBT therapist does and the areas they help users focus on.
CBTp Briefs and Tip Sheets
Fact Sheet: Cognitive Behavioral Therapy for Psychosis
This fact sheet written by Dr. Kate Hardy provides an explanation of CBT, CBT for psychosis, and early intervention principles as it relates to CBTp; a case example of using CBTp with a client presenting with concerns related to auditory hallucinations; and training requirements for clinicians who are interested in practicing CBTp. It was developed for SAMHSA/CMHS under Contract Reference: HHSS283201000021/Task Order No. HHSS28342002T.
Journal Article: Stepped Care Model for
CBT for Psychosis
Stepped care interventions have shown promise as an applied treatment delivery model across settings and interventions. This peer-reviewed article by Drs. Sarah Kopelovich, Harry Sivec, Eric Strachan, and Valerie Kreider describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
Journal Article: Integration of
Two Psychotherapy Evidence-Based Practices within Coordinated Specialty Care Services for Early Psychosis
This brief report by Dr. Kate Hardy and colleagues provides an overview of individualized resiliency training and cognitive-behavioral therapy for psychosis. Elements of synergy between the two models are identified and opportunities for an integrated approach highlighted.
Journal Article: CBTp-based Guided Self-Help Delivered by Frontline Mental Health Professionals: Results of a Feasibility Study
The purpose of this study by Drs. Naeem, Lecomte, and colleagues was to determine the feasibility of a CBTp-based Guided Self-help (CBTp-GSH) in comparison to Treatment As Usual (TAU). Individuals who received the Treatment improved more than those in Control group. The results of this feasibility study indicate that CBTp based Guided Self-help is feasible and acceptable to the participants, and it can lead to improvement in psychopathology and the level of disability.
Journal Article: Statewide Implementation of CBTp Through a Learning Collaborative Model
A Learning Collaborative is a systematic approach to process improvement based on the Institute for Healthcare Improvement Breakthrough Series Collaborative model. In this article, authors Kopelovich, Hughes, Monroe-DeVita, Peterson, Cather, and Gottlieb describe a CBTp Learning Collaborative piloted in Washington State. Fifty-six providers attended an in-person training followed by six months of biweekly consultation sessions (Phase 1). Twenty-one providers participated in an additional six months of consultation (Phase 2). The article reports on implementation facilitators, barriers, and outcomes.
Journal Article: Point prevalence of Cognitive Behavioral Therapy for psychosis (CBTp) training in the U.S. and Canada
This paper (Kopelovich et al., 2022) represents the first effort to estimate the population of CBTp practitioners, characterize trainer qualifications and training practices, and calculate a CBTp accessibility estimate. Twenty-five CBTp trainers completed the questionnaire. Respondents were predominantly white female psychologists in hospital or academic settings. Their estimates of practitioners trained in the past 15 years yielded a point prevalence of 0.57% of the combined mental health workforce, corresponding to 11.5–22.8 CBTp-trained providers for every 10,000 people diagnosed with a psychotic disorder. Survey results showed several differences in training approaches, settings, and funders.
Journal Article:
A Smartphone Intervention for People with Serious Mental Illness: CORE
The CORE intervention designed to increase the cognitive flexibility of individuals struggling with a range of mental health problems through brief daily training. CORE was specifically designed to help counteract dysfunctional thoughts in multiple domains that are relevant to the subjective experience of having SMI. The intervention comprises daily brief game-like exercises designed to produce changes in the relative activation of adaptive and maladaptive beliefs about the self, others, and the world such that adaptive beliefs would be more easily retrieved than maladaptive ones.
Journal Article:
Group Cognitive Behaviour Therapy for
Supported Employment
The current study by Dr. Tania Lecomte and colleagues is aimed at determining the impact of a brief cognitive behaviour therapy group intervention adapted for supported employment programs (called CBT-SE) on the work outcomes of: obtaining a competitive job, number of weeks worked, and number of hours worked per week. Participants were randomized to either receive the 8-session CBT-SE group on top of their supported employment program, or to only receive their support employment program. The results show that those who received CBT-SE were significantly more likely to obtain a job and worked a significantly greater number of hours. these results suggest that a brief cognitive-behavioural intervention specifically tailored to work-related issues can be greatly beneficial.
Peer-Reviewed Publications
Books
"Recovering the US Mental
Healthcare System"
This book reviews the history and current state of research to provide a nuanced understanding of the evidence for and barriers to psychosocial care for psychosis. It addresses a wide range of mental health research and multi-professional practice domains from historical, personal, societal, professional, and systems perspectives. With contributions by members of the NACBTp, including Drs. Charlie Davison (editor), Marci Gather, and Helen Wood, this book represents an essential resource for students, practitioners and researchers.
"Recovery-Oriented Cognitive Therapy for Serious Mental Health Conditions"
This book by Dr. Aaron T. Beck and colleagues describes recovery-oriented cognitive therapy (CT-R), which aims to help individuals shift from a “patient” mode to an adaptive mode of living and take positive steps to pursue valued aspirations. Vivid case vignettes and sample dialogues illustrate ways to access the adaptive mode with people experiencing negative symptoms, delusions, hallucinations, communication difficulties, self-harming or aggressive behavior, and other challenges.
"Schizophrenia:
Cognitive Theory, Research, and Therapy"
From Dr. Aaron T. Beck and colleagues, this volume integrates cognitive-behavioral and biological knowledge into a comprehensive conceptual framework to examine the origins, development, and maintenance of key symptom of psychosis. Treatment chapters offer concrete guidance for addressing each type of symptom, complete with case examples and session outlines.
"Treating Psychosis: A Clinician's Guide to Integrating Acceptance and Commitment Therapy, Compassion-Focused Therapy, and Mindfulness Approaches within the Cognitive Behavioral Therapy Tradition"
"Treating Psychosis," authored by Dr. Nicola Wright and colleagues, is an evidence-based treatment guide for mental health professionals working with individuals affected by psychosis. Using a CBT approach that incorporates acceptance and commitment therapy, compassion-focused therapy, and mindfulness approaches, the guide provides session-by-session clinical interventions for use in individual or group treatment. It has been translated into Persian by Sadegh Abedi and Arjmand Publishing has released 'Treating Psychosis'.
"Psychosocial Approaches to Negative Symptoms in Psychosis"
“This new book, co-edited by Drs. Tania Lincoln, Marie Brown, and David Kimhy, is the first book focusing on psychosocial approaches to the assessment and treatment of negative symptoms, recognized as some the most debilitating and challenging-to-treat aspects of psychotic disorders. The book, which includes 21 chapters (384 pages) by 43 international authors, aims to be a valuable resource for both clinicians and researchers. It addresses a critical gap in knowledge by introducing the reader to risk factors and markers of negative symptoms (e.g., interpersonal, pathophysiological), lived experience perspectives, assessment approaches (e.g., clinical & subjective ratings, behavioral methods, digital phenotyping), as well as evidenced-based and emerging psychosocial and behavioral treatments (e.g., CBT, social skills training, exercise interventions).”
"Group CBT for psychosis:
A Guidebook for Clinicians"
The purpose of this book, lead authored by Dr. Tania Lecomte, is to make group CBT for psychosis more accessible to clinicians everywhere. The book describes how to conduct group CBT for psychosis and covers the theoretical background behind the intervention, summarizes the various studies conducting in CBT for psychosis, explains essential therapeutic elements needed to conduct group CBT for psychosis, and covers different group interventions inspired by our group CBT for psychosis approach. This book will be useful for students, clinicians, and researchers interested in group CBT for psychosis.
Other evidence-based interventions using CBTp principles or techniques for psychotic symptoms
The attached list is not exhaustive but covers various interventions that use CBTp techniques, principles, or target cognitive biases, in order to help people with their psychotic symptoms. The NACBTp Steering Committee, in partnership with the Research Work Group, will maintain this list as new empirical support emerges. Other interventions using CBT strategies have been developed and validated with people with psychotic disorders but do not specifically target psychotic symptoms and are therefore not presented here (e.g. CBT for trauma, CBT for supported employment, CBT for social anxiety, CBT for sleep disturbance).
Not all of the interventions listed have received the same empirical support. Some have been extensively studied in several randomized-controlled trials (and even meta-analyses), whereas others have only been studied in one or two clinical trials, but demonstrate promising findings. As a Network, we do not to promote or favor any specific intervention above another.
other cbtp
Apps
CBT Smartphone Applications
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