Outcomes of Cognitive Behavioral Therapy (CBT) Interventions Provided by Unlicensed Professionals
Outcomes of Cognitive Behavioral Therapy (CBT) Interventions Provided by Unlicensed Professionals
To examine the effectiveness and clinical care outcomes of cognitive-behavioral therapy
 interventions at Massachusetts General Hospital (MGH).
Cognitive behavioral interventions are the most widely studied and evidenced-based
 psychosocial treatment approaches for mental health and health related behavioral problems.
 Despite their documented efficacy, there is a scarcity of licensed mental health
 professionals who are available to treat patients with problems that would be amenable to
 Cognitive Behavioral Therapy (CBT). While CBT interventions have a strong base in terms of
 efficacy in randomized trials, effectiveness and dissemination studies are lacking in
 comparison, and hence, these interventions are not reaching the patients in most need of
 services. Complicating the problem further, insurance companies typically do not reimburse
 for services provided by trainees who are not licensed. This is a public mental health
 problem because it limits the degree to which CBT clinicians can be trained to deliver these
 treatments, and a particular problem at MGH because referring providers do not have a place
 to send their patient for CBT services, as trainees constitute a large portion of clinical
 staff. To address this issue, the current study seeks to document outcomes of CBT
 interventions delivered by credentialed but not licensed trainees. This information can be
 used to guide policy and reimbursement guidelines for trainees, as well as promote the
 ability to disseminate efficacious interventions. Information gained from this project will
 be used to provide feedback to insurance companies, licensing boards, and mental health
 community stakeholders regarding decision making re: reimbursement for care provided by
 supervised trainees. Additionally, this may be used as a pilot study for a comparative
 effectiveness study comparing trainees to licensed staff psychologists.
Inclusion Criteria:

 -  Patients presenting to the Behavioral Medicine Service are generally individuals with
 an acute or chronic medical condition or medically related concern with or without an
 associated DSM-IV psychiatric disorder, as well as adult patients who require
 assistance with changing health or health-risk behaviors. Patients presenting to the
 OCD program typically have obsessive compulsive disorder, body dysmorphic disorder,
 Tourette syndrome, compulsive skin picking, or trichotillomania. Patients presenting
 to the general CBT program typically have panic disorder, social phobia, generalized
 anxiety disorder, depression, specific phobia, post traumatic stress disorder,
 attention deficit hyperactivity disorder, or an eating disorder. Patients at any of
 the programs have an identifiable behavior or behavioral pattern/ mood problem that
 they would like to change.

 -  Age 18 or older

 -  Ability to provide informed consent and comply with the study procedures

 -  Ability to complete self-report questionnaires (either written hardcopy or
 computer-based version) with adequate accommodation, if necessary

 -  Patients with a PCP at MGH, receiving specialty care at MGH, or employees of MGH.

 Exclusion Criteria:

 -  Exhibit active suicidality (suicidal ideation with intent or plan) to the point that
 more intensive treatment (i.e. acute hospitalization) is required.

 -  Active untreated and unstable bipolar disorder (i.e. stable bipolar disorder under
 care of a psychiatrist is allowed).

 -  Psychosis.

 -  Mental retardation.

 -  Any condition that, after the baseline evaluation, is determined to preclude treatment
 with cognitive behavioral therapy.

 -  Received more than 4 sessions of CBT for the target disorder within the past 3 years.