By Judith S. Beck, PhD, Beck Institute President and Sarah Fleming, BA, Public Relations Specialist
The following blog post is the second part of an article published in the German journal Verhaltenstherapie und Psychosoziale Praxis (Behavior Therapy and Psychosocial Practice). Read part one here; part three coming soon. Download the full article in German here.
2013 marked a change in direction for Beck Institute. Dr. Aaron Beck and I decided to tackle a problem in the field. Through decades of research, it was now firmly established that CBT was an effective treatment for many problems individuals were facing, from depression and anxiety to personality disorders, substance use, trauma, and suicide—but many people who needed help were faced with insurmountable barriers. Effective treatment was often not available in their locale; if it was, it was often not affordable, accessible, or appropriately adapted to patients’ culture, age, educational level, or other important characteristics. Many settings used manuals, created for research studies, which failed to consider co-morbidities, problems in the therapeutic relationship, or the need for treatment based on an individualized cognitive conceptualization. Many people received ineffective treatment, or worse, no treatment at all.
The Affordable Care Act had just been passed in the United States, encouraging the use of evidence-based treatments. CBT was the most highly-researched form of psychotherapy in the world, but there just were not enough well-trained cognitive therapists to meet the growing need. We decided it was time to engage with a broader audience. We knew that we had untapped potential to bring training out from behind our walls and into the places where it was needed most.
The following year, under the leadership of a new executive director, BI increased its impact through partnerships with organizations and agencies that benefited from training in evidence-based therapies and through creating new programs that brought training to places where the need was greatest. Acknowledging the growing global mental health crisis, we increased our outreach to social workers, paraprofessionals, peer specialists, and organizations and agencies that treat difficult-to-reach populations in underserved communities.
We also built our online presence during this time. Through our social media pages and YouTube channel, we created and distributed free videos, blogs, and downloadable worksheets for both professionals and consumers. The short videos provided clinical guidelines for therapists and explained aspects of CBT to the lay public. Blogs were written by expert BI faculty members, discussing clinical issues in the treatment of particular disorders. We also began releasing an electronic version of our newsletter, which contained clinically-oriented articles, in addition to highlighting new research, resources, and training opportunities. Through our social media presence and e-newsletter, we have been able to reach over 300,000 individuals, increasing awareness of CBT among both professionals and the lay public.
One major project was the development of BI’s first online CBT training program. The program originated in 2016 with a multi-week course in the Essentials of CBT, followed by additional multi-week courses in CBT for Depression, CBT for Anxiety, and CBT for Personality Disorders. The courses, which I scripted and taught alongside other Beck Institute faculty, included lectures, course manuals, recordings of full therapy sessions, clinical roundtable discussions, practice exercises, enrichment material, and an interactive forum where participants could engage with one another and with Beck Institute’s faculty members. These courses have now been taken by thousands of clinicians in 128 countries. Most of the practitioners who have taken these courses would never otherwise have been able to access this kind of in-depth training in CBT.
Another major initiative was to expand Beck Institute’s Training for Organizations program. This initiative allowed many professionals who worked in hospitals, residential settings, health systems, universities, mental health systems and agencies, and forensic settings to receive CBT training for the first time, which, in turn, allowed them to serve specific populations that had previously not had access to evidence-based therapy. And we were able to help many of these organizations foster sustainability through a train-the-trainer model, creating a pervasive culture change that benefited the organization’s staff and clients for years to come.
One such notable project was with Wolverine Human Services, an adolescent residential behavioral health organization. After conducting a needs assessment, BI developed a multi-level approach to train supervisors, therapists, and support staff. In training this last group, our faculty used a skills-based approach, identifying key issues requiring intervention and providing training in relevant core CBT skills—thus complementing the conceptualization-driven approach provided by the therapists. This method of training reduced the need for physical restraint by staff and increased therapist competence on the CTRS (Lewis, et al., 2018). Other notable organizational training projects during this time included:
- a three-year project with a large veterans services organization, where we provided training in suicide prevention, group CBT, and substance use disorders; and
- a training project tailored to the unique needs of the Native American community.
We also provided training for organizations in international locations such as Turkey, Russia, India, and Australia.
In 2017, in recognition of our decades-long history of training prominent CBT scholars, we decided to hold an annual conference among worldwide leaders in the field. The Beck Institute Excellence Summit was designed to highlight the latest work of top researchers and academics, many of whom had studied with us throughout the years, and to provide opportunities for networking and future collaborations. In 2018, we established the annual Beck Institute Excellence Award, to recognize individuals, organizations and initiatives that improve lives through the promotion of evidence-based mental health practices. Recipients, each of whom received the award at one of the yearly Summits, were:
- Arthur C. Evans, PhD, the Chief Executive of the American Psychological Association, and the former commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services who, together with Dr. Aaron Beck, expanded consumer access to CBT, with a particular focus on the economically challenged, immigrant communities, and the severely mentally ill.
- David M. Clark, DPhil, who spent decades studying, developing, and testing new and effective CBT treatments for anxiety disorders and who created the groundbreaking Improving Access to Psychological Therapies (IAPT) Program, which resulted in a massive overhaul of the mental health treatment system in England (and since adopted in other countries), demonstrating that improving public mental health is not only possible, but is also cost-effective.
- Patrick J. Kennedy, a former US Representative who advanced evidence-based practices, policies, and programming in mental health and addiction and who was the lead author of the Mental Health Parity and Addiction Equity Act, which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer.
Ever since the establishment of the Beck Institute, I regularly attended state, national, and international conferences, presenting keynote speeches and workshops on CBT to colleagues around the world. I gave invited lectures at conferences in Turkey, Peru, Germany, Bulgaria, Hong Kong, Israel, Romania, England, Slovenia, Greece, and many other countries. Many attendees expressed a need for more training and resources in CBT in their respective countries. In 2019, having decided to create a formal connection with international CBT colleagues to help guide our work, we established the Beck Institute International Advisory Committee (IAC). The IAC is comprised of a council of leaders from 16 countries around the world with special expertise in research, implementation science and dissemination, training and Supervision, and a willingness to further our mission.
Throughout this period of rapid growth for Beck Institute, Dr. Aaron Beck had been collaborating with his team of researchers and clinicians at the University of Pennsylvania to develop and test an adaptation of cognitive therapy for individuals diagnosed with serious mental health conditions, some of whom had been institutionalized for decades. Recovery-Oriented Cognitive Therapy (CT-R), based on the Cognitive Model, is rooted in evidence-based principles of CBT and public health, and promotes connection, purpose, hope, empowerment, and resilience (Beck et al, 2020). In 2019, these researchers, faculty, clinicians, and staff started the Center for Recovery-Oriented Cognitive Therapy at Beck Institute. They continue to train teams of mental health professionals, paraprofessionals and peers across the country, adapting CT-R for forensic settings, state hospitals, programmatic residences, and community teams, in large state and municipal systems, as well as in specific agencies and services. Initial research supports the efficacy of this approach in treating individuals and preventing relapse (Grant, et al., 2012; Grant, et al., 2017).
At the same time, we instituted another initiative: Beck Institute’s CBT Certification program. We recognized that more and more mental health professionals were promoting themselves as CBT therapists but did not deliver treatment with fidelity to the Cognitive Model. They often incorporated some cognitive and behavioral techniques into their practice but worked from a different theoretical framework. Others, who may have initially practiced CBT, had drifted from the model over years of clinical practice. Individuals seeking CBT were finding it difficult to determine whether they were actually receiving adequate treatment. Our Certification program was designed to help mental health professionals meet high standards of competency and then to reduce therapist drift by requiring re-certification. The program was initiated in August of 2019 and has attracted applicants from 54 countries.
Beck Institute’s Supervision program has grown rapidly in the past few years. In 2020, we conducted individual and group Supervision with over 90 trainees from 15 different countries, including Egypt, Japan, South Africa, Turkey, Montenegro, United Kingdom, Saudi Arabia, Kazakhstan, Singapore, Germany, Russia, and Mexico. BI has conducted over 8,000 supervision sessions for more than 740 supervisees since 1994.
Also in 2020, we published two important books. The first is the third edition of my textbook, Cognitive Behavior Therapy: Basics and Beyond, which had been translated into 20 languages, and which now incorporates a recovery orientation. Second, Dr. Aaron Beck and colleagues published Recovery-Oriented Cognitive Therapy for Serious Mental Health Conditions, which details flexible, generative CT-R strategies and interventions and reflects the authors’ desire to make the approach accessible to a wide range of professionals and lay persons, including nurses, social workers, administrators, care givers, case workers, and families.
No history would be complete without discussion of the most momentous global event in recent memory: the COVID-19 pandemic. 2020 was a significant year around the world for many reasons, some related to public health, health inequality, and the urgent need for expanded mental health care; and others related to social and racial justice and the volatile political climate. The pandemic and its aftermath brought to the forefront much of the emotional and mental suffering that Beck Institute had been working to alleviate for over 25 years. The need for effective and accessible mental health training and care had never been greater. In March 2020, Beck Institute began conducting all of its activities remotely.
Our faculty has provided a range of free resources for professionals and for the public in response to the growing mental health crisis. Included in these resources are webinars on brief CBT interventions for front-line medical professionals, on using CBT to address the unique challenges of coping with substance use disorder during COVID-19, and on using recovery-oriented principles to flourish, despite the restrictions on close social contact. We also published a list of CBT resources for parents of school-aged children, provided telehealth guidelines for therapists, released free videos with mindfulness exercises, and more. Recognizing the global nature of the health crisis, we published a series of writings and videos from members of our International Advisory Committee, highlighting the complex issues facing countries around the world and the important work being done by the CBT community.
The move to hosting workshops in a live virtual format had unanticipated but positive consequences. The more accessible format allowed twice as many health and mental health professionals to enroll in our workshops compared to the previous year. 1,316 trainees from Algeria, Cyprus, Germany, Singapore and 42 other countries joined one of our live virtual trainings in 2020, receiving over $65,000 in scholarships.
The Beck Institute Excellence Summit was also hosted in a live virtual format in 2020. The academic portion of the Summit was followed by a panel discussion, titled “Understanding the Growing Mental Health Crisis: A Conversation about Access, Advocacy and Parity,” which was open to the public. The panelists contributed rich and unique perspectives to the discussion and answered questions from the audience, which consisted of more than 500 registrants from 48 countries. The conversation focused on the special need for mental health services associated with COVID-19, general access to mental health treatment, the importance of combining medical and mental health care, funding and allocation of resources, and new approaches to organizing and advocacy. The panelists also discussed disparities that exist within the United States health care system and strategies to help shift them in a more equitable direction.