Date of Award

Spring 1-1-2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology & Neuroscience

First Advisor

Sona Dimidjian

Second Advisor

Charles Judd

Third Advisor

Joanna Arch

Fourth Advisor

Arne Beck

Fifth Advisor

David Miklowitz

Abstract

Objective: A large gap exists between need for mental health treatment and access to evidence-based psychological treatments (EBPTs) in clinical practice settings where patients receive care. Developing EBPT training paradigms represents a promising approach to address this problem. This study examined training outcomes amongst a group of non-specialist and behavioral health providers who learned how to deliver behavioral activation (BA) in obstetrics and gynecology settings for the treatment of antenatal depression (AD).

Method: Participants were non-specialist clinicians and behavioral health providers (n = 10 and pregnant women (n = 85 who screened positive for depression during routine prenatal care visits at 4 large health maintenance organizations in Colorado, Georgia, Minnesota and Washington. Clinician training consisted of a 2-day workshop and weekly group supervision. Training outcomes were measured at baseline, post-training, and follow-up using the Therapist Training Evaluation Outcomes Framework (Decker, Jameson, and Naugle, 2011), focusing on satisfaction with training, attitudes towards EBPTs, knowledge of BA, and BA skill acquisition. The relationship between BA skill and patients’ self-reported depressive symptoms during the course of BA treatment was also assessed.

Results: Results indicated that clinicians were satisfied with their training experience and significantly improved over the training period on measures of BA knowledge and skill acquisition; however, they evidenced decreased favorable attitudes towards EBPTs. In contrast to predictions, BA skill failed to significantly predict changes in patients’ self-reported depressive symptoms.

Conclusions: Training non-specialists and behavioral health providers may be a feasible and effective approach to increasing access to EBPTs in routine clinical settings; however, the extent to which such training predicts patient improvement requires additional research. In addition, future work is necessary to draw causal inferences about the impact of training on knowledge and skill in implementing EBPTs.

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