title: National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes.
abstract: OBJECTIVE
  The Department of Veterans Affairs (VA) health care system is nationally disseminating and implementing cognitive behavioral therapy for depression (CBT-D). The current article evaluates therapist and patient-level outcomes associated with national training in and implementation of CBT-D in the VA health care system.
  
  
  METHODS
  Therapist competencies were assessed with the Cognitive Therapy Rating Scale (CTRS). Patient outcomes were assessed with the Beck Depression Inventory-II and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed with the Working Alliance Inventory-Short Revised. Two-hundred twenty-one therapists have received training, and 356 veteran patients have received treatment through the VA CBT-D Training Program.
  
  
  RESULTS
  Of therapists who have participated in the program, 182 (82%) completed all training requirements and achieved competency, reflected by a score of 40 on the CTRS. Of 356 patients, nearly 70% completed 10 or more sessions or improved sufficiently to stop therapy before the 10th session. Mean depression scores decreased by approximately 40% from initial to later treatment phase. Effect sizes of changes ranged from d = 0.39 to d = 0.74 for quality of life and from d = 0.47 to d = 0.66 for therapeutic alliance measures.
  
  
  CONCLUSIONS
  National training in and implementation of CBT-D within the VA health care system is associated with significant, positive therapist training outcomes, as evidenced by increases in CBT core competencies. The implementation of the protocol by newly trained CBT-D therapists is associated with significantly improved patient outcomes, as evidenced by large decreases in depression and improvements in quality of life.
authors: Office of Mental Health Services, U.S. Department of Veterans Affairs Central Office, 810 Vermont Avenue NW, Washington, DC 20420, USA. bradley.karlin2@va.gov
authors: Bradley E
authors: BE
authors: Karlin
authors: Gregory K
authors: GK
authors: Brown
authors: Mickey
authors: M
authors: Trockel
authors: Darby
authors: D
authors: Cunning
authors: Antonette M
authors: AM
authors: Zeiss
authors: C Barr
authors: CB
authors: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D003695:Delivery of Health Care; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health