Establishing Spanish- and English-Speaking CBT Groups for Depression in a Training Clinic

1. Establishing Spanish- and English-Speaking CBT Groups for Depression in a Training Clinic Velma Barrios, Ph.D. Margareth Del Cid Ashley Elefant Palo Alto University

2. Overview • Practice guidelines for group CBT for depression in a training clinic • Creating Spanish- and English-speaking therapy groups • Selection of therapists • Training and supervision of therapists • Cultural considerations applied to CBT • Collaboration planning with administration • Treatment outcome research • Study’s rationale and aims • Future directions

3. Creating Spanish- and English-Speaking Therapy Groups • Participant recruitment • The Gronowski Center, training clinic at Palo Alto University • Referrals from clinic supervisors and/or student therapists • Community • Referrals from outside agencies • All referrals are contacted by phone and suitability to group is then determined • Referrals new to the Gronowski Center • Undergo clinic’s assessment procedure • Are assigned an individual therapist

4. Selection of Therapists • Recruitment of Spanish- and English-speaking therapists • Second-year therapists at the Gronowski Center apply for opportunity to co-lead CBT group for depression, with approval of their supervisor • Two Spanish-speaking and two English-speaking therapists are selected for each Spanish and English CBT group, every year

5. Training and Supervision of Therapists • Training of CBT for depression • Weekly training by supervisor, using manual: “Thoughts, Activities, People and Your Mood” (Miranda, Woo, Lagomasino, Hepner, Wiseman, & Muñoz, 2006) • 3 modules with four sessions per module • Cognitive: Focus on awareness of helpful & harmful thoughts and how they impact mood • Behavioral: Importance of pleasant activities and behavioral activation in improving mood • People: Impact of positive and negative social relationships on one’s mood • Total of 12 weekly, 1.5 hour sessions

6. Training and Supervision of Therapists • Supervision • All sessions are video recorded • Weekly individual supervision • Weekly group supervision • Therapists for Spanish-speaking group • Discussion of cultural considerations applied to CBT • Drs. Muñoz & Barrera serve as consultants in the implementation of group CBT

7. Cultural Considerations Applied to CBT • Strategies to improve treatment engagement by Latinos • Engagement-related factors (e.g., attrition, adherence) • Logistic (e.g., multiple competing demands, transportation) • Attitudinal factors (e.g., outcome expectancies, stigma) • Also, impact of client’s perceived cultural fit, beliefs about causes for depression, & therapist-client ethnic match

8. Collaborative Planning with Administration • Supervisor acts as program coordinator, serving as ongoing link between (1) CBT therapists and (2) clients and administration • Supervisor meets with clinic’s administration to: • Inform of objectives and processes of treatment groups • The better informed, the more likely the groups will operate smoothly • Administration provides tangible (physical) resources and institutional support for successful groups

9. Treatment Outcome Research: Rationale • Efficacy of CBT has been documented for diverse mental health problems, including depression • However, limited rates of participation by Latinos in research • Do efficacious treatments generalize to Latinos? • Limited research on this topic is of substantial concern when considering the expanding of Latino population, particularly in California, Texas, and Arizona (Census 2010) • Urgent need for effective, disseminative treatment of depression, particularly for the fastest-growing Latino population

10. Treatment Outcome Research: Rationale • Closely examining the effectiveness of evidence-based treatments among Latinos is well-founded and of considerable public health significance • Recent reports highlight disparities in access to depression treatment among Latinos (Alegría et al., 2008) and a call for evidence-based interventions to address existing disparities (Muñoz & Mendelson, 2005) • The treatment of depression in Latinos is particularly important, given that depression is one of the most prevalent, distressing, and disabling psychiatric disorders, and its course tends to be chronic if untreated • Further, investigating such treatments in a Spanish-speaking sample is a promising aspect of effectiveness research

11. Treatment Outcome Research: Study Aims • Investigate baseline differences in depression & related affective distress, and overall functioning between Spanish- & English-speaking participants • Report analyses examining difference in clinical effectiveness of CBT for depression in Spanish- & English-speaking participants • Differences in treatment response at 1-, 3-, and 6-months follow up

12. Future Directions • Improve access to evidence-based interventions, particularly to Latinos, by training therapists with little or no CBT experience • Improve quality of care among Latino clients by training culturally-competent providers • Training of more bilingual therapists to improve quality of care of Spanish-speaking Latinos • CBT groups for anxiety