Training, Supervision and Competence

An online training programme is available for CBT-E, which describes and illustrates the treatment in detail. It incorporates features to help trainees grasp key concepts and master the main procedures. The website is designed to be used while also reading relevant sections from the therapist’s guide “Cognitive Behavior Therapy and Eating Disorders. The CBT-E training website is interactive in nature and includes an extensive “library” of acted illustrations of the treatment, something that is impossible to provide in conventional workshops.

The website has been developed by the Centre for Research on Eating Disorders at Oxford and its development has been funded by The Wellcome Trust.

The Current Availability of Web-Based Training

The online training programme in CBT-E is now available to any eligible therapist who wants to receive training at no cost. Access to the training is funded by Health Education England in partnership with Oxford Health NHS Foundation Trust.

Many therapists worldwide have received the training (over 3,500 to date). Given the scalability of this training, CBT-E “has the potential to help millions of people affected by eating disorders around the world” (Wellcome 2017 Annual Report).

Information Sheet – Web-Centred Training in Enhanced CBT (CBT-E) for Eating Disorders

For further information or to request access contact: cbte.training@gmail.com

Please note that we receive a large volume of queries, therefore it may take 3-4 few weeks before you receive a response.

Important notice for CBT-E Web-based Training Queries: Please remember to check all of your email accounts (including junk) that you may have used to contact us for a response. Before gaining access you should receive an email from cbte.training@gmail.com with your login details and a link to a survey. Your login details will not work until this survey has been completed and may take up to 5 days to be activated. Please do this before contacting us with queries.

Introductory and Advanced Workshops

Introductory and advanced workshops on CBT-E are organised periodically. Please view the News and Events section for further information or contact cbte.training@gmail.com for other training enquiries. .

Clinical Supervision

Expert clinical supervision may be available via videoconferencing (or face-to-face if local) by a member of the CBT-E Training Group. There will be a charge for supervision in line with going rates charged by other centres that provide CBT supervision. For further information please contact: credoenquiries@psych.ox.ac.uk.

Background to Web-Based Training in CBT-E

Training therapists in how to implement a specialised psychological treatment typically involves three components. The first is attending an introductory “workshop” given by an expert in the treatment concerned. This provides an overview of the intervention and its strategies and procedures. The second is the reading of written material describing the treatment (often referred to as a treatment “manual” or “guide”). The third involves supervision in implementing the treatment from someone proficient in it. The first and third components are not scalable, least of all in the global context. Few experts are available to give workshops and/or sufficiently experienced to provide supervision. New approaches to training are therefore required.

CBT-E has been the focus of a major research program on how to disseminate psychological treatments (funded by the Wellcome Trust). This has centred on whether it is possible to train therapists remotely via the internet. The result has been the development of a new form of training, described above, designed to be capable of training large numbers of geographically dispersed therapists simultaneously.

The Evaluation of Web-Based Training

CREDO have evaluated the effectiveness and acceptability of web-based training in CBT-E. The research on this online form of training has shown it to be popular, effective and highly scalable. The website has been researched for use in two ways; either with no external input (independent training) or with encouragement from a non-specialist support worker (guided training).

The first step was a proof-of-concept study involving a cohort of therapists spread across Ireland who received guided training (Fairburn et al, 2017). Next, CREDO conducted a randomized controlled trial that recruited therapists from across North America (Cooper et al, 2017). This study compared the use of independent training with guided training. Lastly, in large cohort of therapists from over 30 different countries CREDO further investigated the effectiveness and acceptability of independent training (O’Connor et al, 2018). The findings of these three studies indicated that:

  1. Web-based training is acceptable to therapists, with therapists completing the large majority of training modules
  2. Training is effective with or without guidance
  3. Training works best when carried out alongside treating a suitable patient (a training case)
  4. Training works best when all modules are completed
Therapist Competence

CREDO have developed and evaluated methods of assessing therapists’ competence to deliver CBT-E.  Therapists’ ability to deliver treatment competently is of importance for at least three reasons:

  1. Therapists have a duty to deliver the best possible care or treatment
  2. Competence needs to be assessed in order to evaluate if training is effective
  3. Studies of the efficacy of treatment can only be validly assessed if treatments were delivered competently
eMeasure

CREDO has developed and validated a scalable online “eMeasure” to assess therapists’ applied knowledge of CBT-E. (Cooper et al, 2015). The measure is brief, consisting of 22 items addressing trainee knowledge and understanding of CBT-E and its implementation (i.e. applied knowledge). It has been shown to have sound psychometric properties. The instrument generates a total score. Best cut points to distinguish those trainees who are competent from those who are not have been identified. Importantly, this scalable measure was relatively efficient at predicting competence as assessed by a performance-based measure (described below). Three equivalent versions exist, making the measure suitable for repeat testing of trainee clinicians in outcome studies.

Performance-based measure of competence

CREDO has also developed a performance-based measure of competence to assess therapists’ skill at implementing CBT-E (Cooper et al, 2017). This structured role play based measure assesses actual performance in a simulated setting. It is suitable for assessing training outcome and may serve to complement the highly scalable applied knowledge eMeasure. This measure could also potentially be used as a formative training tool.  The measure has been evaluated by the CREDO team with the following results:

  • It is possible to assess trainees on a range of interventions within an hour
  • Inter-rater reliability was good to excellent for averaged ratings
  • The measure was acceptable to therapists
  • The measure was sensitive to change
  • Trainees rated their performance on the measure as similar to their usual performance

For further information on therapist competence and these measures please contact zafra.cooper@yale.edu

Further Reading

Khera, C. K., Viljoen, D., Murphy, R. (2021). Scaling up training in a leading psychological treatment for eating disorders: The online training of therapists in CBT-E. Clinical Psychology Forum, 343.

O’Connor M, Morgan KE, Bailey-Straebler S, Fairburn CG, Cooper Z Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists J Med Internet Res 2018;20(6):e10386

Cooper, Z., Bailey-Straebler, S., Morgan, K. E., O’Connor, M. E., Caddy, C., Hamadi, L., & Fairburn, C. G. (2017). Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods. Journal of Medical Internet Research, 19(10), e355. doi:10.2196/jmir.8336

Cooper Z, Doll H, Bailey-Straebler S, Kluczniok D, Murphy R, O’Connor ME, et al. The development of an online measure of therapist competence. Behav Res Ther 2015 64:43-48

Cooper, Z., Doll, H., Bailey-Straebler, S., Bohn, K., de Vries, D., Murphy, R., . . . Fairburn, C. G. (2017). Assessing Therapist Competence: Development of a Performance-Based Measure and Its Comparison With a Web-Based Measure. Journal of Medical Internet Research Mental Health, 4(4), e51. doi:10.2196/mental.7704

Fairburn CG, Allen E, Bailey-Straebler S, O’Connor ME, Cooper Z Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists J Med Internet Res 2017;19(6):e214

Fairburn CG, Cooper Z. Therapist competence, therapy quality, and therapist training. Behav Res Ther 2011 49(6-7):373-378