North America CBTp Network: Evolution from an Idea to an Entity

The first application of Cognitive Behavioral Therapy (CBT) in treating an individual with psychotic symptoms was described by the progenitor of Cognitive Therapy, Dr. Aaron T. Beck, in 1952. However, it took another four decades before researchers would systematically examine the clinical efficacy of CBT for psychosis (CBTp). Since the early studies in CBTp in the late 20th and early 21st centuries, over 60 randomized controlled trials have been published. The results of these studies, and subsequent meta-analyses, demonstrated that CBTp reduced positive and negative symptoms and improved functioning (Turner, Van Der Gaag, Karyotaki, & Cuijpers, 2014; Wykes, Steel, Everitt, & Tarrier, 2008). The promise of these clinical outcomes led to policy change in the United Kingdom stating that all individuals with a diagnosis of schizophrenia should have access to at least 16 sessions of CBTp (National Collaborating Centre for Mental Health, 2014). In the United States and Canada, national schizophrenia treatment guidelines also called for CBTp as an adjunctive treatment to medication management, but efforts to translate clinical guidelines into standard of care have proven less successful in North America  (Dixon et al., 2009). In the United States, for example, it is estimated that just 0.1% of the clinical workforce are trained in CBTp (Mueser & Noordsy, 2005). In order to facilitate access to the recommended treatment, the clinical workforce requires training and consultation and the systems in which they operate—typically publicly-funded community agencies—require thoughtful and evidence-based approaches to implementing CBTp.

 

The North America CBTp Network was conceived in 2015 by Drs. Kate Hardy and Sally Riggs; two British trained clinical psychologists who had observed national training efforts in the United Kingdom support widespread national implementation of CBTp. As regular attendees of the International CBTp Meeting, Sally and Kate returned from the meeting in Philadelphia, 2015, determined to create a network that would emulate the passion, collegiality, and commitment evident within the international CBTp community. The initial aim was to provide a community forum for national CBTp experts in North America to connect with one another, coordinate around training ventures, and facilitate discourse regarding national implementation in the United States. Since the inception of the network, the mission has evolved to include a commitment to ensuring the standard of high quality training and to establish competency standards for CBTp (and emerging associated practices) in North America. In April 2018, the steering committee was formally established. However, the most important phase of the network has only just commenced – an opportunity for those who are interested in advancing CBT for psychosis accessibility (regardless of professional background, license-eligibility, or training level) to join the North American CBTp Network. We look forward to having you join us on this journey.

 

Beck, A. T. (1952). Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry, 15, 305-312.

 

Dixon, L. B., Dickerson, F., Bellack,  a. S., Bennett, M., Dickinson, D., Goldberg, R. W., … Kreyenbuhl, J. (2009). The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophrenia Bulletin, 36(1), 48–70. https://doi.org/10.1093/schbul/sbp115

 

Mueser, K. T., & Noordsy, D. L. (2005). Cognitive behavior therapy for psychosis: A call to action. Clinical Psychology: Science and Practice, 12(1), 68–71. https://doi.org/10.1093/clipsy/bpi008

 

National Collaborating Centre for Mental Health. (2014). Psychosis and schizophrenia in adults: treatment and management. Nice, Feb 54 Clinical Guidelines n° 178.

 

Turner, D. T., Van Der Gaag, M., Karyotaki, E., & Cuijpers, P. (2014). Psychological interventions for psychosis: A meta-analysis of comparative outcome studies. American Journal of Psychiatry, 171, 523–538. https://doi.org/10.1176/appi.ajp.2013.13081159

 

Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34(3), 523–537. https://doi.org/10.1093/schbul/sbm114

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