Testing the Utility of a Competence Scale for CBT-ED Therapists

This study aims to test the utility of a newly developed clinician competence scale for those delivering Cognitive-Behaviour Therapy for Eating Disorders (CBT-ED), specifically assessing the inter-rater reliability of the measure.

Cognitive-behavioural therapy for eating disorders (CBT-ED) is currently one of the NICE (2017) recommended treatments for anorexia nervosa and the only treatment recommended for bulimia nervosa, binge-eating disorder and other specified feeing and eating disorders. When clinicians adhere to evidence-based CBT-ED treatment manuals, CBT-ED has shown demonstrable levels of effectiveness in a range of eating disorders, comparable to outcomes in controlled research settings. A key component of CBT-ED found so effective in the treatment of eating disorders is a stronger focus on behavioural change tasks which is key for changing biased thinking. However, clinicians often drift from using behavioural change components and instead focus more on the cognitive aspects of therapy, or indeed drift away from treatment manuals substantially. Therefore, a suitable measure that can accurately assess how well a clinician is delivering the therapeutic competences that ensures patients are receiving evidence-based CBT-ED thus providing them with the best chance of reaching maximum recovery is important. Whilst numerous scales have been developed, none have yet been found suitable for eating disorders, as they do not have a strong focus on the key behavioural aspects of CBT-ED. Therefore, a team of clinical researchers developed the Cognitive Behaviour Therapy Scale for Eating Disorders (CBTS-ED). This pilot study will use CBT-ED therapy session audio-recordings, and different expert and non-expert raters to a) assess the inter-rater reliability of the CBTS-ED and b) assess whether the CBTS-ED can accurately detect improvement in competence among clinicians currently undergoing post-graduate diploma training in CBT-ED. The findings from this study will provide information about the reliability of the CBTS-ED scale and its possible future uses in predicting patient outcomes.

National Institute for Health and Care Excellence (2017). Eating disorders: recognition and treatment (NICE guideline NG69). Available at: https://www.nice.org.uk/guidance/ng69

Eligibility Criteria:
Therapist Inclusion Criteria:

* Qualified clinicians with a core National Health Service (NHS) profession currently undergoing post-graduate diploma training in CBT-ED at either the University of Sheffield or University College London (UCL), or;
* Qualified clinicians not on the CBT-ED training course but delivering CBT-ED
* Treating adult (18+ years) eating disorder patients
* Have a good understanding of written and verbal English

Patient Inclusion Criteria:

* Primary diagnosis of an eating disorder
* Accessing CBT-ED
* Aged 18+ years
* Have a good understanding of written and verbal English
* Have the capacity to provide written informed consent

Rater Inclusion Criteria:

* Specialists in the field of CBT-ED, or;
* Qualified clinicians who do not ordinarily work with eating disorder patients, or;
* CBT-ED trainees at Sheffield University or UCL, or;
* CBT-ED training course supervisors at Sheffield University or UCL
* Have a good understanding of written and verbal English

Therapist Exclusion Criteria:

* Non-qualified clinicians
* Non CBT-ED clinicians
* Clinicians only treating children or young people with eating disorders (aged 17 years or younger)
* Have little understanding of written and verbal English

Patient Exclusion Criteria:

* Non-eating disorder patients
* Eating disorder patients who are accessing treatment other than CBT
* Aged 17 years or younger
* Have little understanding of written and verbal English
* Lack the capacity to understand the project and provide written informed consent

Rater Exclusion Criteria:

- Little understanding of written and verbal English