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Establishing Spanish- and English-Speaking CBT Groups forDepression in a Training ClinicEstablishing Spanish- and English-Speaking CBT Groups forDepression in a Training Clinic
Velma Barrios, Ph.D.Velma Barrios, Ph.D.
Margareth Del CidMargareth Del Cid
Ashley ElefantAshley Elefant
Palo Alto UniversityPalo Alto University
OverviewOverview
Practice guidelines for group CBT fordepression in a training clinicPractice guidelines for group CBT fordepression in a training clinic
–Creating Spanish- and English-speaking therapygroups–Creating Spanish- and English-speaking therapygroups
–Selection of therapists–Selection of therapists
–Training and supervision of therapists–Training and supervision of therapists
Cultural considerations applied to CBTCultural considerations applied to CBT
–Collaboration planning with administration–Collaboration planning with administration
–Treatment outcome research–Treatment outcome research
Study’s rationale and aimsStudy’s rationale and aims
–Future directions–Future directions
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Creating Spanish- and English-Speaking Therapy GroupsCreating Spanish- and English-Speaking Therapy Groups
Participant recruitmentParticipant recruitment
–The Gronowski Center, training clinic at PaloAlto University–The Gronowski Center, training clinic at PaloAlto University
Referrals from clinic supervisors and/or studenttherapistsReferrals from clinic supervisors and/or studenttherapists
–Community–Community
Referrals from outside agenciesReferrals from outside agencies
–All referrals are contacted by phone andsuitability to group is then determined–All referrals are contacted by phone andsuitability to group is then determined
–Referrals new to the Gronowski Center–Referrals new to the Gronowski Center
Undergo clinic’s assessment procedureUndergo clinic’s assessment procedure
Are assigned an individual therapistAre assigned an individual therapist
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Selection of TherapistsSelection of Therapists
Recruitment of Spanish- and English-speaking therapistsRecruitment of Spanish- and English-speaking therapists
–Second-year therapists at the GronowskiCenter apply for opportunity to co-lead CBTgroup for depression, with approval of theirsupervisor–Second-year therapists at the GronowskiCenter apply for opportunity to co-lead CBTgroup for depression, with approval of theirsupervisor
–Two Spanish-speaking and two English-speaking therapists are selected for eachSpanish and English CBT group, every year–Two Spanish-speaking and two English-speaking therapists are selected for eachSpanish and English CBT group, every year
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Training and Supervision ofTherapistsTraining and Supervision ofTherapists
Training of CBT for depressionTraining of CBT for depression
–Weekly training by supervisor, using manual:“Thoughts, Activities, People and Your Mood”(Miranda, Woo, Lagomasino, Hepner, Wiseman, &Muñoz, 2006)–Weekly training by supervisor, using manual:“Thoughts, Activities, People and Your Mood”(Miranda, Woo, Lagomasino, Hepner, Wiseman, &Muñoz, 2006)
–3 modules with four sessions per module–3 modules with four sessions per module
Cognitive: Focus on awareness of helpful & harmfulthoughts and how they impact moodCognitive: Focus on awareness of helpful & harmfulthoughts and how they impact mood
Behavioral: Importance of pleasant activities andbehavioral activation in improving moodBehavioral: Importance of pleasant activities andbehavioral activation in improving mood
People: Impact of positive and negative socialrelationships on one’s moodPeople: Impact of positive and negative socialrelationships on one’s mood
–Total of 12 weekly, 1.5 hour sessions–Total of 12 weekly, 1.5 hour sessions
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Training and Supervision ofTherapistsTraining and Supervision ofTherapists
SupervisionSupervision
–All sessions are video recorded–All sessions are video recorded
Weekly individual supervisionWeekly individual supervision
Weekly group supervisionWeekly group supervision
–Therapists for Spanish-speaking group–Therapists for Spanish-speaking group
Discussion of cultural considerations applied toCBTDiscussion of cultural considerations applied toCBT
Drs. Muñoz & Barrera serve as consultantsin the implementation of group CBTDrs. Muñoz & Barrera serve as consultantsin the implementation of group CBT
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Cultural ConsiderationsApplied to CBTCultural ConsiderationsApplied to CBT
Strategies to improve treatment engagementby LatinosStrategies to improve treatment engagementby Latinos
–Engagement-related factors (e.g., attrition,adherence)–Engagement-related factors (e.g., attrition,adherence)
–Logistic (e.g., multiple competing demands,transportation)–Logistic (e.g., multiple competing demands,transportation)
–Attitudinal factors (e.g., outcome expectancies,stigma)–Attitudinal factors (e.g., outcome expectancies,stigma)
–Also, impact of client’s perceived cultural fit, beliefsabout causes for depression, & therapist-clientethnic match–Also, impact of client’s perceived cultural fit, beliefsabout causes for depression, & therapist-clientethnic match
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Collaborative Planning withAdministrationCollaborative Planning withAdministration
Supervisor acts as program coordinator,serving as ongoing link between (1) CBTtherapists and (2) clients and administrationSupervisor acts as program coordinator,serving as ongoing link between (1) CBTtherapists and (2) clients and administration
Supervisor meets with clinic’sadministration to:Supervisor meets with clinic’sadministration to:
–Inform of objectives and processes of treatmentgroups–Inform of objectives and processes of treatmentgroups
The better informed, the more likely the groups willoperate smoothlyThe better informed, the more likely the groups willoperate smoothly
Administration provides tangible (physical) resourcesand institutional support for successful groupsAdministration provides tangible (physical) resourcesand institutional support for successful groups
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Treatment Outcome Research:RationaleTreatment Outcome Research:Rationale
Efficacy of CBT has been documented for diversemental health problems, including depressionEfficacy of CBT has been documented for diversemental health problems, including depression
–However, limited rates of participation by Latinosin research–However, limited rates of participation by Latinosin research
Do efficacious treatments generalize toLatinos?Do efficacious treatments generalize toLatinos?
Limited research on this topic is of substantialconcern when considering the expanding of Latinopopulation, particularly in California, Texas, andArizona (Census 2010)Limited research on this topic is of substantialconcern when considering the expanding of Latinopopulation, particularly in California, Texas, andArizona (Census 2010)
Urgent need for effective, disseminative treatment ofdepression, particularly for the fastest-growing LatinopopulationUrgent need for effective, disseminative treatment ofdepression, particularly for the fastest-growing Latinopopulation
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Treatment Outcome Research:RationaleTreatment Outcome Research:Rationale
Closely examining the effectiveness of evidence-basedtreatments among Latinos is well-founded and ofconsiderable public health significanceClosely examining the effectiveness of evidence-basedtreatments among Latinos is well-founded and ofconsiderable public health significance
–Recent reports highlight disparities in access to depressiontreatment among Latinos (Alegría et al., 2008) and a call forevidence-based interventions to address existing disparities(Muñoz & Mendelson, 2005)–Recent reports highlight disparities in access to depressiontreatment among Latinos (Alegría et al., 2008) and a call forevidence-based interventions to address existing disparities(Muñoz & Mendelson, 2005)
The treatment of depression in Latinos is particularlyimportant, given that depression is one of the mostprevalent, distressing, and disabling psychiatric disorders,and its course tends to be chronic if untreatedThe treatment of depression in Latinos is particularlyimportant, given that depression is one of the mostprevalent, distressing, and disabling psychiatric disorders,and its course tends to be chronic if untreated
Further, investigating such treatments in a Spanish-speaking sample is a promising aspect of effectivenessresearchFurther, investigating such treatments in a Spanish-speaking sample is a promising aspect of effectivenessresearch
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Treatment Outcome Research:Study AimsTreatment Outcome Research:Study Aims
Investigate baseline differences indepression & related affective distress, andoverall functioning between Spanish- &English-speaking participantsInvestigate baseline differences indepression & related affective distress, andoverall functioning between Spanish- &English-speaking participants
Report analyses examining difference inclinical effectiveness of CBT for depressionin Spanish- & English-speaking participantsReport analyses examining difference inclinical effectiveness of CBT for depressionin Spanish- & English-speaking participants
–Differences in treatment response at 1-, 3-, and6-months follow up–Differences in treatment response at 1-, 3-, and6-months follow up
Future DirectionsFuture Directions
Improve access to evidence-basedinterventions, particularly to Latinos, bytraining therapists with little or no CBTexperienceImprove access to evidence-basedinterventions, particularly to Latinos, bytraining therapists with little or no CBTexperience
Improve quality of care among Latinoclients by training culturally-competentprovidersImprove quality of care among Latinoclients by training culturally-competentproviders
Training of more bilingual therapists toimprove quality of care of Spanish-speakingLatinosTraining of more bilingual therapists toimprove quality of care of Spanish-speakingLatinos
CBT groups for anxietyCBT groups for anxiety
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