Learning to do therapy for depression – A new way

Learning to do therapy for depression – A new way

Written by Dr. Kala Mehta, Dr. Dolores Gallagher-Thompson, Annecy Majoros and Nate Gardner

Depression is very common in the US, but there aren’t enough therapists and psychiatrists to address this large need. The American Psychological Association estimates that 17 million adults live with depression in the US, and there are only an estimated 4,000 therapists in the US to provide evidence based treatment, like Cognitive Behavioral Therapy (CBT). CBT has been used to treat a wide variety of psychiatric problems including anxiety, post-traumatic stress disorder, and depression of various levels of severity. There is a strong empirical base in that over 100 randomized trials have been conducted demonstrating the efficacy of this approach – both by itself and in combination with anti-depressant medication.  In this course our goal was not to fully train psychotherapists in how to do CBT – that requires hands-on supervision over time – but to introduce CBT to a naïve group of practitioners, give them an opportunity to learn both didactic and hands-on skills, and evaluate whether or not they were using the skills in their clinical practice.

Depression Map of US

Data Source: CDC. Current Depression Among Adults — United States, 2006 and 2008. MMWR 2010;59(38);1229-1235.

Recognizing that there are quite a few experts at Stanford (such as Drs. Dolores Gallagher-Thompson, Ph.D. and Kim Bullock, M.D.) and virtually hundreds of individuals who wanted these skills, we came to the VPOL for guidance. We presented them with a challenge. Teaching therapy goes beyond the usual. We didn’t need a person speaking in front of a set of power-point slides like a classic webinar, we needed something better, deeper, and more ‘hands on’. We needed a system to impart softer ‘clinical skills’ that come with practice.  We also needed a way to understand whether students ‘got it’. To know, that in fact the learners acquired the right skills, and would feel confident that they could provide therapy if on their own in appropriate situations. How could we do all of that online?

Luckily the Stanford Vice Provost for Online Learning team had already paved the way in this arena. We had assembled an enthusiastic team in the Department of Psychiatry to innovate and bring it all together (Dr. Dolores Gallagher-Thompson, Dr. Kim Bullock, Dr. Kala Mehta, Nate Gardner, Marian Tzuang and Annecy Majoros). Dr. Gallagher-Thompson was our leader. She has taught several hundred graduate students and professionals on how to use CBT in older adults, but not online. The methods she developed have been very successful so we decided to start with her original creations. Dr. Kim Bullock, a psychiatrist and innovator was an incredibly valuable co-investigator in this effort as her precise, defined way of imparting CBT to medical doctors was just the voice of clarity we needed to get these ‘soft’ ideas online.

We decided to make this a blended-learning course.  It contained quick, interactive lectures, an opportunity for quizzes to gauge real-time learning, and an opportunity for students to role-play and get feedback—all online! We hosted face-to-face sessions for students to discuss their role playing and to learn from each other. This sounds too good to be true, in fact it was a journey to get there.

The class lasted 7 weeks. We sought out a specific group for this pilot course – graduate students in pursuit of their PhDs in Clinical Psychology at Palo Alto University. The emphasis was on developing basic clinical skills and the essential component of receiving feedback from and having access to the instructors and teaching assistants. We wanted the students to be able to immediately start using the skills they were learning.  One of the ways we did this was through role play exercises and providing them with handouts that they could use in their own therapy sessions. Students were presented with lectures to learn CBT but were also given role play videos to watch where these specific skills were successfully executed (role plays were led by Dr. Gallagher-Thompson, Dr. Kim Bullock and other mental health providers). Then their assignment was to perform their own role plays with a partner using a case vignette. Comments on the role plays included: “most helpful part of the class by far” and as a recommendation for future courses, “complete a role play every week of the course.” So, we learned that students wanted to do more and really practice their skills. They also requested more: assignments, mandatory meetings, more difficult and lengthy quizzes and feedback from their peers on their role plays.

CBT Screenshot

CBT 101: Introduction to Cognitive Behavior Therapy Course on the OpenEdX Online Learning Platform

Along the way, we learned many lessons and are considering all of the student feedback to incorporate it into a course update and our next version for mental health providers. Aside from student requests for more work (and more difficult assessments), we learned a great deal about technology and the complications that occur when people are either not tech-savvy or simply have bad internet connections – such as when they are on a lunch break and trying to connect with a mobile device to our live meetings (this works poorly by the way).

We also had weekly check-ins with students where they had access to the instructor or teaching assistants. Here students could ask their burning questions about using CBT with older adults and even how to apply CBT to the specific patients they were seeing. The students found this helpful, but still not quite sufficient as they recommended that these live sessions, “should be mandatory”. It was clear that these students were hungry for CBT knowledge and they wanted to know that they were ‘getting it right’ so they could succeed.  We hope that this is the beginning of harnessing the best blended learning technology for clinical skills in mental health, and this is a first step in the right direction.

If you’re interested in the course or in collaborating to develop other online courses for clinical skill-building, please contact us: stanfordgec@stanford.edu