Is Supervision Necessary? Examining the Effects of Internet-Based CBT Training With and Without Supervision

Objective: To investigate the effect of Internet-based training (IBT), with and without supervision, on therapists’ (N = 61) cognitive behavioral therapy (CBT) skills in routine clinical practice.

Method: Participants were randomized into three conditions: (1) Internet-based training with use of a consultation worksheet (IBT-CW), (2) Internet-based training with CBT supervision via Skype (IBT-S), and (3) ‘delayed-training’ control who did not receive the training until all data collection was completed (DT). The IBT conditions received access to training over a period of three months. CBT skills were evaluated at pre-, mid- and post- training / wait using assessor competence ratings of recorded therapy sessions.

Results: Hierarchical linear analysis revealed that the IBT-S condition had significantly greater CBT competence at post training than IBT-CW and DT conditions at both the mid- and post-training/ wait assessment points. There were no significant differences between IBT-CW and the delayed (no)-training control (DT) conditions.

Conclusions: IBT programs that include supervision may be a scalable and effective method of disseminating CBT into routine clinical practice, particularly for populations without ready access to more traditional ‘live’ methods of training. There was no evidence for a significant effect of IBT without supervision over a non-training control, suggesting that merely providing access to IBT programs may not be an effective method of disseminating CBT to routine clinical practice.

Public Health Significance Statement: This study highlights the importance of providing supervision during an Internet-based CBT training program, particularly when therapists are applying newly acquired skills in routine clinical practice.