Towards scalable training: narrowing the research-practice gap in the treatment of eating disorders

Empirically supported treatments (ESTs) now exist for a variety of psychological disorders; however, few individuals have access to these treatments and even fewer receive them in well delivered form. This has been termed the research-practice gap. It is likely that a combination of factors contribute to individuals not receiving good quality ESTs. One major reason is the limited availability of effective training in these treatments. Although many therapists wish to learn such treatments, they seldom have the opportunity as training relies on scarce expert resources and is costly. Furthermore, relatively little is known about the effectiveness of this method or how best to train clinicians: despite having evidence-based treatments, there are no evidence-based trainings.
This dissertation examined one example of an EST - enhanced cognitive behavior therapy for eating disorders (CBT-E) – with the overarching aim of evaluating both existing, and commonly accepted, training methods, as well as, newly developed more scalable ones. How best to train clinicians in CBT for eating disorders has not been investigated previously. The Kirkpatrick training evaluation framework was adopted to guide the studies. Chapter One provided an overview of the research-practice gap with a particular emphasis on the obstacles faced in training therapists. Chapter Two reviewed the literature on training in ESTs and highlighted gaps in the research evidence and areas for improvement in future studies. An important conclusion was that, although studies varied in design and the precise form and content of the training investigated, results were mostly consistent in indicating that knowledge and skills tended to improve following training. However, the outcome measures used to assess training were often poorly described with unknown psychometric properties. Perhaps most importantly the lack of clearly defined competence cut-points made interpretation difficult. In addition, much of the training investigated had limitations in terms of scalability. Chapters Three, Four and Five, aimed to overcome some of these difficulties and provided a series of studies investigating training in CBT-E. Chapter Three employed qualitative methods to investigate trainees' reaction to conventional workshop and more scalable web-based training and found that although trainees enjoyed training, they had a variety of reasons for not planning to implement the treatment as learned. Chapters Four and Five evaluated the impact of different forms of training on knowledge and skill acquisition respectively. Training in CBT-E was associated with increases in knowledge especially when paired with supervision or scalable guidance, which proved feasible and acceptable to clinician trainees. The results for skill acquisition were less clear, but the new scalable online training was associated with therapists achieving competence. Finally Chapter Six discussed the broader implications of the work and highlighted areas for future research.

Keywords: evidence based training
workshop training
competence
scalable
therapist training
scalability
eating disorders training
online training
training
conventional training
Advisor: Cooper, Z