title: Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: therapist and patient outcomes.
abstract: OBJECTIVE
  The U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.
  
  
  METHODS
  Therapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).
  
  
  RESULTS
  Three-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = -20.3, p < 0.001. Quality of life scores also increased.
  
  
  CONCLUSIONS
  Training in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, USA.
authors.forename: Robyn D
authors.initials: RD
authors.lastname: Walser
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Karlin
authors.forename: Mickey
authors.initials: M
authors.lastname: Trockel
authors.forename: Barbara
authors.initials: B
authors.lastname: Mazina
authors.forename: C
authors.initials: C
authors.lastname: Barr Taylor
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000193:education* / Q000379:methods; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003863:Depression / Q000628:therapy*; D004059:Diffusion of Innovation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011788:Quality of Life; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Acceptance and Commitment Therapy; Depression; Dissemination; Veterans