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

Velma Barrios, Ph.D.Velma Barrios, Ph.D.

Margareth Del CidMargareth Del Cid

Ashley ElefantAshley Elefant

Palo Alto UniversityPalo Alto University

OverviewOverview

Practice guidelines for group CBT for Practice guidelines for group CBT for depression in a training clinicdepression in a training clinic– Creating Spanish- and English-speaking Creating Spanish- and English-speaking

therapy groupstherapy groups– Selection of therapistsSelection of therapists– Training and supervision of therapistsTraining and supervision of therapists

Cultural considerations applied to CBTCultural considerations applied to CBT

– Collaboration planning with administration Collaboration planning with administration – Treatment outcome researchTreatment outcome research

Study’s rationale and aimsStudy’s rationale and aims

– Future directionsFuture directions

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Creating Spanish- and Creating Spanish- and English-Speaking Therapy English-Speaking Therapy GroupsGroups Participant recruitmentParticipant recruitment

– The Gronowski Center, training clinic at Palo The Gronowski Center, training clinic at Palo Alto UniversityAlto University

Referrals from clinic supervisors and/or student Referrals from clinic supervisors and/or student therapiststherapists

– CommunityCommunity Referrals from outside agenciesReferrals from outside agencies

– All referrals are contacted by phone and All referrals are contacted by phone and suitability to group is then determinedsuitability to group is then determined

– Referrals new to the Gronowski Center Referrals new to the Gronowski Center Undergo clinic’s assessment procedureUndergo clinic’s assessment procedure Are assigned an individual therapistAre assigned an individual therapist

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Selection of TherapistsSelection of Therapists

Recruitment of Spanish- and English-Recruitment of Spanish- and English-speaking therapistsspeaking therapists– Second-year therapists at the Gronowski Second-year therapists at the Gronowski

Center apply for opportunity to co-lead Center apply for opportunity to co-lead CBT group for depression, with approval CBT group for depression, with approval of their supervisorof their supervisor

– Two Spanish-speaking and two English-Two Spanish-speaking and two English-speaking therapists are selected for each speaking therapists are selected for each Spanish and English CBT group, every Spanish and English CBT group, every yearyear

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Training and Supervision Training and Supervision of Therapistsof Therapists Training of CBT for depressionTraining of CBT for depression

– Weekly training by supervisor, using manual: Weekly training by supervisor, using manual: “Thoughts, Activities, People and Your Mood” “Thoughts, Activities, People and Your Mood” (Miranda, Woo, Lagomasino, Hepner, Wiseman, (Miranda, Woo, Lagomasino, Hepner, Wiseman, & Muñoz, 2006)& Muñoz, 2006)

– 3 modules with four sessions per module3 modules with four sessions per module Cognitive: Focus on awareness of helpful & Cognitive: Focus on awareness of helpful &

harmful thoughts and how they impact moodharmful thoughts and how they impact mood Behavioral: Importance of pleasant activities and Behavioral: Importance of pleasant activities and

behavioral activation in improving moodbehavioral activation in improving mood People: Impact of positive and negative social People: Impact of positive and negative social

relationships on one’s moodrelationships on one’s mood– Total of 12 weekly, 1.5 hour sessionsTotal of 12 weekly, 1.5 hour sessions

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Training and Supervision Training and Supervision of Therapistsof Therapists SupervisionSupervision

– All sessions are video recordedAll sessions are video recorded Weekly individual supervisionWeekly individual supervision Weekly group supervisionWeekly group supervision

– Therapists for Spanish-speaking groupTherapists for Spanish-speaking group Discussion of cultural considerations applied to Discussion of cultural considerations applied to

CBTCBT

Drs. Muñoz & Barrera serve as Drs. Muñoz & Barrera serve as consultants in the implementation of consultants in the implementation of group CBTgroup CBT

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Cultural Considerations Cultural Considerations Applied to CBT Applied to CBT Strategies to improve treatment Strategies to improve treatment

engagement by Latinosengagement by Latinos– Engagement-related factors (e.g., attrition, Engagement-related factors (e.g., attrition,

adherence) adherence) – Logistic (e.g., multiple competing demands, Logistic (e.g., multiple competing demands,

transportation) transportation) – Attitudinal factors (e.g., outcome expectancies, Attitudinal factors (e.g., outcome expectancies,

stigma) stigma) – Also, impact of client’s perceived cultural fit, Also, impact of client’s perceived cultural fit,

beliefs about causes for depression, & beliefs about causes for depression, & therapist-client ethnic matchtherapist-client ethnic match

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Collaborative Planning Collaborative Planning with Administrationwith Administration Supervisor acts as program coordinator, Supervisor acts as program coordinator,

serving as ongoing link between (1) CBT serving as ongoing link between (1) CBT therapists and (2) clients and therapists and (2) clients and administrationadministration

Supervisor meets with clinic’s Supervisor meets with clinic’s administration to:administration to:– Inform of objectives and processes of treatment Inform of objectives and processes of treatment

groupsgroups The better informed, the more likely the groups will The better informed, the more likely the groups will

operate smoothlyoperate smoothly Administration provides tangible (physical) Administration provides tangible (physical)

resources and institutional support for successful resources and institutional support for successful groupsgroups

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Treatment Outcome Treatment Outcome Research: RationaleResearch: Rationale

Efficacy of CBT has been documented for diverse Efficacy of CBT has been documented for diverse mental health problems, including depressionmental health problems, including depression– However, limited rates of participation by However, limited rates of participation by

Latinos in researchLatinos in research Do efficacious treatments Do efficacious treatments generalizegeneralize to to

Latinos?Latinos? Limited research on this topic is of substantial Limited research on this topic is of substantial

concern when considering the expanding of concern when considering the expanding of Latino population, particularly in California, Latino population, particularly in California, Texas, and Arizona (Census 2010)Texas, and Arizona (Census 2010)

Urgent need for effective, disseminative Urgent need for effective, disseminative treatment of depression, particularly for the treatment of depression, particularly for the fastest-growing Latino populationfastest-growing Latino population

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Treatment Outcome Treatment Outcome Research: RationaleResearch: Rationale

Closely examining the effectiveness of evidence-Closely examining the effectiveness of evidence-based treatments among Latinos is well-founded and based treatments among Latinos is well-founded and of considerable public health significanceof considerable public health significance– Recent reports highlight disparities in access to Recent reports highlight disparities in access to

depression treatment among Latinos (Alegría et al., depression treatment among Latinos (Alegría et al., 2008) and a call for evidence-based interventions to 2008) and a call for evidence-based interventions to address existing disparities (Muñoz & Mendelson, 2005)address existing disparities (Muñoz & Mendelson, 2005)

The treatment of depression in Latinos is particularly The treatment of depression in Latinos is particularly important, given that depression is one of the most important, given that depression is one of the most prevalent, distressing, and disabling psychiatric prevalent, distressing, and disabling psychiatric disorders, and its course tends to be chronic if disorders, and its course tends to be chronic if untreateduntreated

Further, investigating such treatments in a Spanish-Further, investigating such treatments in a Spanish-speaking sample is a promising aspect of speaking sample is a promising aspect of effectiveness researcheffectiveness research

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Treatment Outcome Treatment Outcome Research: Study AimsResearch: Study Aims

Investigate baseline differences in Investigate baseline differences in depression & related affective distress, depression & related affective distress, and overall functioning between and overall functioning between Spanish- & English-speaking Spanish- & English-speaking participantsparticipants

Report analyses examining difference in Report analyses examining difference in clinical effectiveness of CBT for clinical effectiveness of CBT for depression in Spanish- & English-depression in Spanish- & English-speaking participantsspeaking participants– Differences in treatment response at 1-, 3-, Differences in treatment response at 1-, 3-,

and 6-months follow upand 6-months follow up

Future DirectionsFuture Directions

Improve access to evidence-based Improve access to evidence-based interventions, particularly to Latinos, by interventions, particularly to Latinos, by training therapists with little or no CBT training therapists with little or no CBT experience experience

Improve quality of care among Latino Improve quality of care among Latino clients by training culturally-competent clients by training culturally-competent providersproviders

Training of more bilingual therapists to Training of more bilingual therapists to improve quality of care of Spanish-improve quality of care of Spanish-speaking Latinosspeaking Latinos

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