Web-Based Training and Competence

Web-Based Training in Enhanced CBT (CBT-E) for Eating Disorders

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 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.

Please read the Information Sheet including eligibility, then read the detail below.

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.

If you have questions related to the detail here please email cbte.training@gmail.com.   Please note: we receive a large volume of queries, therefore it may take 3-4 weeks before you receive a response.  Please be patient, we will get back to you as soon as possible.

Availability of Web-Based Training

  • For NHS and HSE therapists
    The online training programme in CBT-E is available to any eligible National Health Service (NHS) and Health Service Executive (HSE) therapist who wants to receive training at no cost.  Click here to register for access.
  • For other therapists who have access to funding for training
    We are charging a relatively small amount for access to support our costs. We will keep this cost as low as possible to encourage access. The cost will be £250 and this will provide you with full access to all material. By paying for this training you will enable to us to continue to offer this service and allow us to provide free access for therapists around the world who do not have any access to funding for training. Click here to register for access.
  • For other therapists providing free healthcare without funding for training
    If you are requesting access from a healthcare service which provides cost free treatment to patients, and you do not have a budget for training. Click here to register for access.

The web-based training is for therapists delivering CBT-E for eating disorders. We recommend that parents and people with eating disorders use a different set of resources. Please view our Self-Help Programmes and Resources for Parents pages for more detail.

Associated Practical Guide Book: The website is designed to be used while also reading relevant sections from the therapist’s guide Cognitive Behavior Therapy and Eating Disorders by Christopher FairburnThis is available to buy separately to the web-based training (or you may be able to access this via a local library or similar).

Certificate of Completion

We do not offer formal accreditation in CBT-E.  We are able to offer a certificate of completion, which indicates you have spent around 10 hours completing the main training course (note that we will check your seat time so only do this once you have completed all modules of the main course). The course is designed to be completed over a period of between two and six months. You may be able to use this as part of your continuing professional development but we cannot provide further guidance on this.

For NHS and HSE therapists the certificate is free of charge, on request, via cbte.training@gmail.com. For other therapists, we charge a small admin payment of £25. Please click here to purchase.

You can explore the supplementary modules and library as needed. These provide around 30 hours of further materials. As these are optional, depending on your need, they do not form part of the completion certificate.

Purchasing a number of accounts

If you are interested in registering a group of therapists for web-based training accounts please email us.  We can provide reduced rates and bulk registration for ease of set up.  Please email cbte.training@gmail.com. 

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

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

Therapist Self-rated CBT-E Components Checklist (CBT-E CC)

The CBT-E Components Checklist (CBT-E CC) is designed for learning to help therapists to reflect on and develop their skills.

Bailey-Straebler S, Cooper Z, Dalle Grave R, Calugi S, Murphy R. Development of the CBT-E Components Checklist: A tool for measuring therapist self-rated adherence to CBT-E. IJEDO. 2022;4. doi: https://www.doi.org/10.32044/ijedo.2022.02Download PDF


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