Cognitive Processing Therapy in the Democratic Republic of Congo: Moving From RCT to Implementation

Saturday 10:30 – 11:45 Breakout D3

Presentor: Debra Kaysen

Debra Kaysen, University of Washington; Cindy Stappenbeck, University of Washington; Monika Bakayoko-Topolska, International Rescue Committee; Katie Robinette, International Rescue Committee; Viviane Maroy, International Rescue Committee; Paul Bolton, Johns Hopkins University, Bloomberg School of Public Health ; Judith Bass, Johns Hopkins University, Bloomberg School of Public Health


There is high need for mental health care services for sexual violence victims in eastern Democratic Republic of Congo (DRC) but few services exist. In a recent randomized clinical trial (RCT),  Congolese  psychosocial assistants delivered group Cognitive Processing Therapy – Cognitive (CPT-C) in community mental health settings, with significant improvements in PTSD, depression, and overall functioning (Bass et al., 2013). A recent first stage implementation study trained 14 health workers employed in public health facilities in delivery of Group CPT-C. Fifty four women participated in CPT-C groups in the implementation study and we compared results to the 158 women and 7 counselors from the original RCT in terms of symptoms scores, change in symptoms over time, and whether study (i.e., RCT vs. implementation) impacted symptom change. We conducted a generalized estimating equation (GEE) and specified an autocorrelation of 1, a Gaussian distribution with an identity link, and robust standard errors. We found symptoms significantly decreased across the 12 sessions, b = -1.90, 95% confidence interval (CI): -1.99, -1.82), p < .001. Change in symptoms did not differ for those in the RCT versus implementation study, b = -0.07, 95% CI: -0.32, 0.19, p = .61. Results suggest complex cognitive behavioral therapies can be implemented and delivered in low resource community health settings by paraprofessionals.

Impact of Training and Clinician Allegiance on Adherence to DBT Model in a Public Sector Mental Health Team in Australia

Saturday 10:30 – 11:45 Breakout D3

Presentor: Carla Walton

Carla Walton, Centre for Psychotherapy, Hunter New England Mental Health Service & University of Newcastle



The Centre for Psychotherapy is a public sector specialist service for Borderline Personality Disorder in Newcastle, Australia. We conducted a Randomised Clinical Trial of Dialectical Behaviour Therapy (DBT) and the Conversational Model (CM; a psychodynamic therapy) for individuals with Borderline Personality Disorder between 2007 and 2014. Some therapists delivered the intervention in both therapy arms of the trial, some DBT only and some CM only. All therapists treating patients in the DBT arm of the study had some training in DBT before commencing in the trial. Ten days of DBT intensive training then occurred in 2010. Throughout the duration of the trial, sessions were audio recorded. Adherence coding was conducted on a subset of sessions for each therapist-patient dyad for both DBT and CM. Adherence coding was commenced in 2013 and feedback was not provided to the therapists during the trial. Therapists self-rated regarding their allegiance to each treatment model as well as being rated by other therapists in the service regarding their therapeutic allegiance. This presentation will focus particularly on DBT and will report on the impact of training as well as cliniciansʼ allegiance on adherence scores, with a focus on whether potential improvements from DBT intensive training were sustained in the long-term


Rates and Predictors of Implementation after Dialectical Behavior Therapy Intensive Training

Saturday 10:30 – 11:45 Breakout D3

Presentor: Melanie Harned

Melanie S. Harned, University of Washington & Behavioral Tech, LLC; Marivi Navarro-Haro, University of Washington; Kathryn E. Korslund, University of Washington; Tianying Chen, University of Washington; Anthony DuBose, Behavioral Tech, LLC; Andre Ivanoff, Behavioral Tech, LLC ; Marsha M. Linehan, University of Washington


Background: Dialectical Behavior Therapy (DBT) Intensive Training is the gold standard for training clinicians to deliver DBT.  This team-based training includes two 5-day workshops separated by a 6-month period for self-study and implementation.  Although DBT Intensive Training has been widely used, little research has evaluated its effectiveness.  The present study evaluates the rates and predictors of implementation of DBT after DBT Intensive Training. Method: Participants were attendees at 9 DBT Intensive Trainings (n= 411 clinicians from 81 teams) conducted from 2012-2013.  All attendees completed self-report measures at Part 1 and Part 2.  In addition, team leaders completed a follow-up survey 6-12 months after Part 2 to assess implementation.  Results: Overall, 75% of teams had implemented all four DBT modes after training.  Only 2% of teams had not implemented any DBT mode.  Teams with fewer training and program needs and more positive attitudes toward evidence-based practice implemented significantly more DBT modes after training.  In contrast, teams with a higher proportion of bachelor’s-level clinicians as well as clinicians with less prior experience delivering DBT implemented significantly fewer DBT modes.  Conclusion: These findings provide evidence of the effectiveness of DBT Intensive Training in promoting implementation of DBT among clinicians from diverse practice settings.