Cognitive Behavioral Therapy for Psychosis (CBTp)
TESTIMONIALS FROM CBTp TRAINED PROVIDERS
“…I was initially daunted by all the training requirements. It was kind of like a class, and I definitely had to do some readings and prep at home. But it paid off big time. The changes I saw my client make were incredible…the fidelity feedback far exceeded my expectations.”
“The ECHO Clinics made the difference for me. The training was great but I never would’ve been able to learn CBTp without the ECHO Clinics…just hearing other people struggling with the same thing…I learned so much from the feedback they got.”
How does Cognitive Behavioral Therapy Help with Psychotic Symptoms?
Addressing an Unmet Need in the Pacific Northwest
Cognitive Behavioral Therapy for psychosis (CBTp) is a time-limited, solutions-focused, structured form of talk therapy that is indicated for individuals who experience distress related to psychotic symptoms.1 CBTp is not a new intervention. In fact, its evidence base spans over 30 years, and it has been studied in more than 50 randomized clinical trials, more than a dozen meta-analyses, and 4 systematic reviews.
Faculty with our center contributed to the most recent systematic review2, which reinforced support for the continued indication of CBTp to address primary psychotic symptoms and secondary mood symptoms. In recognition of the mounting evidence base, CBTp has been recommended by national psychosis treatment guidelines in the US since they were first developed by the American Psychiatric Association in the 1990s.3,4
Unfortunately, CBTp is not widely available in the US. Nationally, it’s estimated that only 0.1% of all licensed clinicians in the United States are trained in CBTp.5 As a result, few Americans are able to access a treatment that is not only intended to be part of standard care, but can address the functional stagnation that occurs without proper attention to values-based, person-centered, and skills-based care.
In recognition of the discrepancy between best and implemented practices, SAMHSA convened a panel of experts in CBTp in 2019. The meeting, chaired by Dr. Kopelovich, identified key barriers to implementation; opportunities to motivate clinicians, administrators, payers, and policymakers to routinely offer CBTp; and strategic implementation and policy recommendations to advance this mission. In 2021, SAMHSA published the written product of this meeting, which can be freely accessed on the SAMHSA website: https://store.samhsa.gov/product/cognitive-behavioral-therapy-for-psychosis/PEP20-03-09-001
Understanding the magnitude of this crisis and science-to-practice gap, the Division of Behavioral Health and Recovery with the Washington State Health Care Authority (HCA) have partnered with SPIRIT since 2014 to systematically implement and disseminate CBTp across publicly-funded behavioral health settings.6,7
In addition, critical innovations, adaptations, and evaluation of empirically-supported implementation strategies have been supported by generous philanthropy. As a result of combined public-private funding, the UW CBTp Implementation Team at SPIRIT developed the first ECHO clinics in the world that focused on treating individuals with psychosis and is home to the first and only CBTp Provider Network in the country. Our team supports more than 300 providers across 20 counties in the Northwest region of the United States and we have provided introductory training to thousands of students, trainees, and practitioners around the globe. We offer opportunities for both in-person and virtual training in CBTp and CBTp-informed care throughout the year. To learn more about open enrollment training opportunities, click here: UW-SPIRIT-CBTp-Training-Opportunities.
In addition to our work in the Pacific Northwest, we also support the SAMHSA-funded Northwest Mental Health Technology Transfer Center (NW-MHTTC), which has a national focus on evidence-based practices for individuals with serious mental illness, including CBTp. You can use these links to learn more about our focus on CBTp as well as see a list of Northwest MHTTC training resources: https://mhttcnetwork.org/centers/northwest-mhttc/resources-serious-mental-illness-smi
1 O’Connor, K. (2021). Psychotherapy Said to Be Key to Successful Psychosis Treatment. Psychiatric News, 56(7). https://doi.org/10.1176/appi.pn.2021.7.22
2 McDonagh, M., Dana, T., Selph, S., Devine, E. B., Cantor, A., Bougatsos, C., Blazina, I., Grusing, S., Fu, R., Kopelovich, S. L., Monroe-DeVita, M., & Haupt, D.W. (2017). Treatments for Schizophrenia in Adults: A Systematic Review. Comparative Effectiveness Review No. 198. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 17(18)-EHC031-EF. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://effectivehealthcare.ahrq.gov/products/schizophrenia-adult/research-2017 doi: 10.23970/AHRQEPCCER198 . PMID: 29537779
3 American Psychiatric Association. (1997).
Practice guideline for the treatment of patients with schizophrenia. Am. J. Psychiatry, 154(4), 1-63.
4 American Psychiatric Association. (2004). Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry, 161(2), 1-57.
5 Kopelovich, S. L., Nutting, E., Blank, J., Buckland, H. T., & Spigner, C. (2022). Preliminary point prevalence of Cognitive Behavioral Therapy for psychosis (CBTp) training in the US and Canada. Psychosis, 1-11.
6 Kopelovich, S. L., Strachan, E., Sivec, H., & Kreider, V. (2019). Stepped care as an implementation and service delivery model for cognitive behavioral therapy for psychosis. Community mental health journal, 55(5), 755-767.
7 Kopelovich, S., Monroe-DeVita, M., Hughes, M., Peterson, R., Cather, C., & Gottlieb, J. (2018). Statewide implementation of cognitive behavioral therapy for psychosis through a learning collaborative model. Cognitive and Behavioral Practice, 26(3), 439-452. doi: 10.1016/j.cbpra.2018.08.004
CBTp FUNDING SOURCES
Washington State Health Care Authority
Private Philanthropic Support through the Cognitive Behavioral Therapy Psychosis (CBTp) Program Fund and the Professorship of Cognitive Behavioral Therapy for Psychosis