Canadian Association Of Cognitive And Behavioural .

Canadian Association of Cognitive andBehavioural Therapies/ AssociationCanadienne des therapies cognitives atcomportementalesNATIONAL GUIDELINES FOR TRAINING IN CBT2019

The Canadian Association of Cognitive and BehaviouralTherapies / l’Association Canadienne des Therapies Cognitiveset Comportementales (CACBT-ACTCC)National Guidelines for Training in CBTApril 23, 2019Preamble:The CACBT-ACTCC is a multidisciplinary organization whose aim isto advance scientific knowledge and research in cognitive andbehavioural therapies (CBT) and to promote and increase access toevidence-based assessment and intervention for health and mentalhealth difficulties. The CACBT-ACTCC was formed in 2010 and witha mandate to promote awareness of the principles of evidencebased psychological treatments and that promotes knowledge ofand access to cognitive-behavioural therapy. The CACBT-ACTCCdoes this by providing a platform for discussing CBT and evidencebased psychotherapy and seeks to educate and inform helpingprofessionals as well as the public about matters pertaining to thescience and practice of CBT. The activities of the CACBT-ACTCCinclude providing quality training in and dissemination of CBTthrough conferences, courses, workshops, public lectures, an emaillistserv, and a website (English site: www.cacbt.ca; French site:www.actcc.ca). The organization also promotes scientific researchof CBT and the dissemination of these findings. Finally, CACBTACTCC has developed a formal certification process for CBTprofessionals to provide a benchmark for quality mental healthservices and an avenue for the public to locate qualified CBTprofessionals (through our online database).The initiative for the current training guidelines arose for severalreasons. One reason is global developments related to trainingstandards for CBT. This document relies on previous work in thisarea and is an effort to become part of the international movementto promote evidence-based therapies, such as CBT. Another factor2

is the current Canadian context, which is increasingly emphasizingevidence-based practice in mental health. We are also mindful ofthe introduction of provincial/territorial initiatives to enhance accessto evidence-based mental health care. Most directly, CACBTACTCC is committed to the enhancement of quality care andwishes to advance this goal through the development andpromulgation of minimum guidelines for the content andcompetencies that should be included in training for CBT.An assumption of this document is that CBT training builds upon thecore knowledge and competencies of regulated health professionals(and trainees) for whom psychotherapy is within their scope ofpractice. These regulated professions may vary acrossprovinces/territories, yet generally include psychologists,psychiatrists and other physicians, social workers, nurses,counsellors, and occupational therapists.These guidelines provide recommendations for both the coreknowledge and competencies that should be included in CBTtraining. Within the scope of psychotherapy we recognize thatthere are both generic skills that apply across different models ofCBT, as well as skills that are specific to particular populations,problems, and models of CBT. It is expected that trainees will seektraining specific to the populations, problems, and CBT models withwhich they work.It is also noted that CBT training consistent with these guidelines isonly one component of the requirements for CACBT-ACTCCcertification. Training is necessary but not sufficient for certification,which also requires clinical experience, letters of support, and worksamples. For details of the certification process, -process/.These guidelines were informed by and drew on the work ofresearchers and clinicians in the field of CBT training. Althoughguidelines from various other agencies and professionalorganizations have been developed, there is a dearth of researchon what constitutes adequate CBT training to ensure fidelity andenhance client outcome. In line with the empirical underpinnings of3

CBT, more research should be conducted on CBT training. Asmore research becomes available these guidelines should beregularly updated so as to reflect the current state of the science onCBT training.We drew on published recommendations for training including thoseoutlined by Muse and McManus (2013), Klepac et al. (2012), andRoth and Pilling (2007). Additionally, we also reviewed establishedtraining programs including those developed by the BritishAssociation of Behavioural and Cognitive Psychotherapies(BABCP), the Improving Access to Psychological Therapies (IAPT)Program in the UK, and the Improving Access to StructuredPsychotherapy (IASP) initiative in Ontario, as well as CBTcertification recommendations developed by BABCP, the Academyof Cognitive Therapy (ACT), the Australian Association for Cognitiveand Behaviour Therapy (AACBT), and of course the certificationrequirements of CACBT-ACTCC. References for these documentsare included at the end of these Guidelines.The process of developing these guidelines began in May 2018.The Board of CACBT-ACTCC explored various ways that CACBTACTCC could be involved in the national and provincial dialogue forincreasing access to mental health services and providingevidence-based treatment. The Board concluded that the mosteffective way to broadly impact training across the country was todevelop training guidelines that stakeholders could consult indeveloping CBT training initiatives. The Board appointed a workinggroup, the mandate of which was to develop a draft of theguidelines. The working group, consisting of Andrea Ashbaugh(Chair of the working group and President-Elect), Jacquie Cohen(Certification Chair), and Keith Dobson (President), completed adraft of the Guidelines in February 2019. These Guidelines werethen circulated to recognized Canadian experts in CBT, includingCACBT-ACTCC Fellows and the Board, for feedback andrecommendations. The Guidelines will be revised and circulatedamong CACBT-ACTCC members and approval of the final versionis anticipated to take place at the May 2019 Board meeting inMontreal, QC.4

Definitions:Cognitive-behavioural therapy (CBT) –CBT is a general model ofpsychotherapy, within which several specific approaches can beidentified, which vary in terms of the target problem(s) they addressand specific intervention components. In general, however, CBTapproaches use a combination of behavioural and cognitiveprinciples and interventions. As defined here, CBT includes theentire scope of treatments within this general model, including thosethat are sometimes referred to as “third wave” CBT. Given thisbroad focus, this document does not attempt to describe everyapproach or specific model within the broad framework of CBT butrather highlights training principles and competencies that arecommon across different approaches to CBT.Guidelines – This document provides guidance about the contentof training, minimum core knowledge, and clinical competenciesthat should be provided as part of CBT training. It is not designedas a regulatory set of standards for CBT training. We anticipate thatthese Guidelines will evolve as the field of CBT evolves.Training –Training broadly encompasses activities that occur in thecontext of professional mental health programs, professionalcontinuing education workshops, courses, certificate programs,supervision and consultation, and other delivery methods. Thistraining can occur in the context of an integrated program of study,a stand-alone course, or a combination of delivery methods.Knowledge – Knowledge refers to the understanding of humanexperience and human change processes based upon theory andscientific evidence. We recognize that knowledge will furtheraccumulate over time as the field develops.Competencies – Competencies are core sets of abilities,behaviors, or skills that a trainee should demonstrate by the end oftraining. Competencies are predicated upon core knowledge andthe experience to know when and how to apply that knowledge. Werecognize that competencies are not static but evolve over time as5

the field develops. Such competencies may be linked tocertification or other forms of credentialing.Core KnowledgeIt is expected that trainees have already attained (or are in theprocess of attaining) foundational knowledge related to thepractice of psychotherapy. These include, but are not necessarilylimited to knowledge and skills pertaining to: professional, regulatory, and ethical guidelines the importance of evidence-based practice inpsychotherapy the role of context, diversity, and individual differences inpsychotherapy, and the related role of treatment providers’own individual characteristics and values client engagement and the development and maintenanceof a therapeutic alliance evidence-based assessment approaches pertaining totreatment planning and ongoing assessment (e.g.,outcome assessment) throughout treatment risk assessment and management case formulation and treatment planning the provision of individual, group, couple, and/or familytreatment modalities as appropriate the coordination of a course of treatment, includingbeginning treatment, navigating treatment sessions,maintaining and modifying treatment as necessary, andending treatment effectively the effective coordination of care, including thecoordination of care among various professionals and theprovision of appropriate referrals psychopathology and mental health problems models pertaining to the appropriate intensity andcomprehensiveness of treatment (e.g., stepped care) the importance of ongoing education, consultation, andsupervision6

The following areas of core knowledge should be covered in thecontext of CBT training: development and history of CBTCBT within the context of the principles and practice ofevidence-based careCBT models of the development and maintenance ofclinical problems and psychopathology, the enhancementof functioning, and goal attainmentsuitability and contra-indications for CBTimpact of stages of change and client engagement on CBToutcomeassessment for CBT case conceptualization and treatmentrole of case monitoring and outcome assessment in CBTadapting CBT for various areas of diversity and individualdifferences (e.g., culture, age, sex and gender, clientpreferences)adapting CBT for co-occurring problems and complexpresentationscriteria for consultation with and/or referral to a specialistthe nature and role of the therapeutic relationship in CBT,including collaborative empiricismthe nature and role of structure in CBT, includingstructuring CBT sessions, setting an appropriateframework for treatment, and ending treatment inaccordance with evidence-based and CBT principlescore areas of intervention in CBT, such as cognitivetherapy, exposure, contingency management, skillstraining, and other core CBT approachesthe importance of generalizing principles, skills, andstrategies to daily lifethe effective use of assignments and homeworkCBT models of maintaining change and relapse preventioncommon challenges in CBT7