Systematic Evaluation of Psychotherapy Training: Supervision, Student Learning, and Patient Outcomes

Study Overview
=================
Brief Summary
-----------------
The project is a longitudinal observation study that aims to systematically evaluate selected parts of the material collected within the framework of the psychotherapy training conducted at the Center of Psychotherapy Education and Research unit at Karolinska Institutet and Region Stockholm, Sweden. Students at the unit, patients being administered psychotherapy by the students, and supervisors will participate in the study. The aim of the present study is to investigate the associations between (1) content and quality of psychotherapy supervision, (2) student therapists' competence, and (3) patient outcomes following student-led psychotherapy.

Detailed Description
-----------------
The project is a longitudinal observation study that aims to systematically evaluate selected parts of the material collected within the framework of the psychotherapy training conducted at the Center of Psychotherapy Education and Research unit at Karolinska Institutet and Region Stockholm, Sweden, from 2023 - 2028. The courses/programs that will be included in the project are the psychotherapist program (six semesters), the specialist training for psychologists in adult psychiatry (six semesters), the basic training in evidence-based psychotherapeutic methods (three semesters), and the basic training in psychotherapy for residents in child, adolescent, and adult psychiatry (two semesters). The element of the programs that will be evaluated is student-led psychotherapy, in which students conduct psychotherapy with patients in the public health care system. The study's research subjects are supervisors, students, and their patients from the unit's student-led psychotherapies. Data consists of material that the supervisors and students have collected within the framework of the educational setting; the data are placed and stored on a secure digital platform (BASS). For objective estimates, the project also intends to code selected audio-recorded psychotherapy and supervision sessions. The primary research questions are: Do psychotherapy students' general and specific psychotherapy competence increase over time during training? Can statistically significant and/or clinically meaningful patient improvements be observed after student-led psychotherapy? Is students' psychotherapy competence significantly associated with patient outcomes? Are aspects (content and quality) of the psychotherapy supervision setting significantly related to improved student therapists' competence? The project also aims to psychometrically evaluate (validity and reliability) some of the included instruments.

Official Title
-----------------
Systematic Evaluation of Psychotherapy Training: Impact of Supervision and Training on Student Learning and Patient Outcomes

Conditions
-----------------
Student Education

Intervention / Treatment
-----------------
* Behavioral: Psychotherapy education


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Students at one of the following courses/programs: Primary training in evidence-based psychotherapeutic methods (three semesters) and specialty trainee (ST) for doctors in child, adolescent, and adult psychiatry (two semesters), the postgraduate psychotherapist program (six semesters), and the specialist training program for clinical psychologists (six semesters). Clinical supervisors for the students in the abovementioned courses/programs. Patients in psychotherapy with students in the abovementioned courses/programs as therapists. The patients are regular patients at public health care facilities in psychiatry and primary care. Students, supervisors, and patients must consent to inclusion. Exclusion Criteria: No exclusion criteria are applied.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Psychotherapy students<br>The participating psychotherapy students will come from the following courses at the Center for Psychotherapy Education and Research: the psychotherapist program (six semesters), the specialist training for psychologists in adult psychiatry (six semesters), the basic training in evidence-based psychotherapeutic methods (three semesters), and the basic training in psychotherapy for residents in child, adolescent, and adult psychiatry (two semesters). | Behavioral: Psychotherapy education<br>* Psychotherapy education, including supervision, lectures, and workshops<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Generalized Anxiety Disorder Assessment 7 (GAD-7) | The GAD-7 is originally a measure for generalized anxiety disorder, but it is also frequently used to assess general anxiety. The form consists of seven items with a four-point scale. The range is 0-21 points. An eight item describes how disruptive the anxiety is from not at all to very significant, which is not included in the total score. The GAD-7 has been translated into Swedish and has shown good psychometric properties in terms of both reliability and validity. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Patient Health Questionnaire-9 (PHQ-9) | The PHQ-9 is a well-established depression questionnaire consisting of nine items that correspond to the diagnostic criteria for a major depressive episode according to the DMS-5. How often the symptoms have bothered the patient in the past two weeks is rated by the patient, at the start and end of treatment, on a four-point scale. The range is 0-27 points. The PHQ-9 has been translated into Swedish and has good internal consistency and test-retest reliability. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The WHO Disability Assessment Schedule (WHODAS 2.0) | The WHODAS 2.0 is a widely used generic assessment instrument that provides a standardized method for measuring health and disability across cultures. The form is based on a set of questions from the International Classification of Functioning, Disability, and Health (ICF) that are sufficiently reliable and sensitive to measure changes after interventions. The form is available in seven different versions with 36 questions, 12 questions, and 12+24 questions as interview-administered, self-administered, and proxy-administered, respectively. In the project, the self-administered 12-question form is used. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Alcohol Use Disorders Identification Test (AUDIT) | The AUDIT is a widely used instrument for identifying hazardous and harmful alcohol consumption. The instrument was initially developed by the WHO and consists of a ten-item questionnaire designed to measure three domains: consumption, dependence, and alcohol-related harm. The project uses a cut-off point of 5 points as an indication of mild alcohol use disorder. The project uses the AUDIT-C, which includes the first three questions of the AUDIT. | Change from pre-treatment to immediately after the end of psychotherapy for those patients scoring above the cut-off at pre-treatment | 
| The Sleep Condition Indicator (SCI) | The SCI will be used to measure sleep disorders. The SCI contains eight questions regarding nocturnal symptoms, function, performance, duration, frequency, and severity. The form is translated into Swedish, and the psychometric properties have been shown in studies to be acceptable to good. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Liebowitz Social Anxiety Scale, self-report (LSAS-SR) | The LSAS-SR is only used for patients with social anxiety disorder or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Panic Disorder Severity Scale - Self-rated (PDSS-SR) | The PDSS-SR is only used for patients with panic disorder or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Penn State Worry Questionnaire (PSWQ) | The PSWQ is only used for patients with generalized anxiety disorder or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Posttraumatic Stress Disorder Checklist, version 5 (PCL-5) | The PCL-5 is only used for patients with posttraumatic stress disorder or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Obsessive Compulsive Inventory-Revised (OCI-R) | The OCI-R is only used for patients with obsessive-compulsive disorder or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Perceived Stress Scale-10 (PSS-10) | The PSS-10 is only used for patients with stress or burnout problems or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Short Health Anxiety Inventory-14 (SHAI-14) | The SHAI-14 is only used for patients with health anxiety problems or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Eating Disorder Examination Questionnaire (EDE-Q) | The EDE-Q is only used for patients with eating disorders or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 
| The Drug Use Disorders Identification Test (DUDIT) | The DUDIT is only used for patients with drug problems or similar. | Change from pre-treatment to immediately after the end of psychotherapy | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
psychotherapy, supervision, student learning, patient outcomes