Outcomes of Cognitive Behavioral Therapy (CBT) Interventions Provided by Unlicensed Professionals

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Brief Title

Outcomes of Cognitive Behavioral Therapy (CBT) Interventions Provided by Unlicensed Professionals

Official Title

Outcomes of Cognitive Behavioral Therapy (CBT) Interventions Provided by Unlicensed Professionals in a General Hospital Setting

Brief Summary

      To examine the effectiveness and clinical care outcomes of cognitive-behavioral therapy
      interventions at Massachusetts General Hospital (MGH).

Detailed Description

      Cognitive behavioral interventions are the most widely studied and evidenced-based
      psychosocial treatment approaches for mental health and health related behavioral problems.
      Despite their documented efficacy, there is a scarcity of licensed mental health
      professionals who are available to treat patients with problems that would be amenable to
      Cognitive Behavioral Therapy (CBT). While CBT interventions have a strong base in terms of
      efficacy in randomized trials, effectiveness and dissemination studies are lacking in
      comparison, and hence, these interventions are not reaching the patients in most need of
      services. Complicating the problem further, insurance companies typically do not reimburse
      for services provided by trainees who are not licensed. This is a public mental health
      problem because it limits the degree to which CBT clinicians can be trained to deliver these
      treatments, and a particular problem at MGH because referring providers do not have a place
      to send their patient for CBT services, as trainees constitute a large portion of clinical
      staff. To address this issue, the current study seeks to document outcomes of CBT
      interventions delivered by credentialed but not licensed trainees. This information can be
      used to guide policy and reimbursement guidelines for trainees, as well as promote the
      ability to disseminate efficacious interventions. Information gained from this project will
      be used to provide feedback to insurance companies, licensing boards, and mental health
      community stakeholders regarding decision making re: reimbursement for care provided by
      supervised trainees. Additionally, this may be used as a pilot study for a comparative
      effectiveness study comparing trainees to licensed staff psychologists.

Study Type


Primary Outcome

The Schwartz Outcome Scale (SOS-10)


Obsessive Compulsive Disorder


Cognitive behavioral therapy (CBT)

Study Arms / Comparison Groups

 Cognitive Behavioral Therapy


* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information

Recruitment Status


Estimated Enrollment


Start Date

January 2010

Completion Date

January 2023

Primary Completion Date

January 2023

Eligibility Criteria

        Inclusion Criteria:

          -  Patients presenting to the Behavioral Medicine Service are generally individuals with
             an acute or chronic medical condition or medically related concern with or without an
             associated DSM-IV psychiatric disorder, as well as adult patients who require
             assistance with changing health or health-risk behaviors. Patients presenting to the
             OCD program typically have obsessive compulsive disorder, body dysmorphic disorder,
             Tourette syndrome, compulsive skin picking, or trichotillomania. Patients presenting
             to the general CBT program typically have panic disorder, social phobia, generalized
             anxiety disorder, depression, specific phobia, post traumatic stress disorder,
             attention deficit hyperactivity disorder, or an eating disorder. Patients at any of
             the programs have an identifiable behavior or behavioral pattern/ mood problem that
             they would like to change.

          -  Age 18 or older

          -  Ability to provide informed consent and comply with the study procedures

          -  Ability to complete self-report questionnaires (either written hardcopy or
             computer-based version) with adequate accommodation, if necessary

          -  Patients with a PCP at MGH, receiving specialty care at MGH, or employees of MGH.

        Exclusion Criteria:

          -  Exhibit active suicidality (suicidal ideation with intent or plan) to the point that
             more intensive treatment (i.e. acute hospitalization) is required.

          -  Active untreated and unstable bipolar disorder (i.e. stable bipolar disorder under
             care of a psychiatrist is allowed).

          -  Psychosis.

          -  Mental retardation.

          -  Any condition that, after the baseline evaluation, is determined to preclude treatment
             with cognitive behavioral therapy.

          -  Received more than 4 sessions of CBT for the target disorder within the past 3 years.




18 Years - N/A

Accepts Healthy Volunteers



Sabine Wilhelm, PhD, , 

Location Countries

United States

Location Countries

United States

Administrative Informations



Organization ID


Responsible Party

Principal Investigator

Study Sponsor

Massachusetts General Hospital

Study Sponsor

Sabine Wilhelm, PhD, Principal Investigator, Massachusetts General Hospital

Verification Date

April 2022