(PS12-A1) Adherence to CBT Among Providers Treating Eating Disorders: The Impact of Training and Attitudes Towards Evidence Based Practice

Introduction: Licensed Mental Health providers who treat clients with eating disorders (EDs) have shown variability in their adherence to empirically supported practices, such as cognitive behavioral therapy (CBT) techniques. Formal training, years practiced, and attitudes about evidence-based practices (EBP) may influence the use of CBT in the treatment of EDs.

Method: Licensed mental health providers (59 Licensed Psychologists (LP) and 162 masters-level providers (MA)) who self-identified as having provided therapy for EDs to >5 patients in the past 12 months were recruited via national listservs, social media posts, and emails to complete an online survey. Participants reported years in clinical practice, sources of CBT training, and attitudes toward EBP (Evidence-Based Practice Attitude Scale; EBPAS). Participants estimated the percentage of ED patients in the past 12 months with whom they implemented 15 CBT skills (e.g., assign self-monitoring of thoughts or feelings) using a 0 to 100% scale with 10-point increments (frequency of adherence (FA)). Participants also estimated the degree to which they used each skill (“none” to “extensively”; quality of adherence (QA)). Factor analysis revealed the items loaded onto three skill clusters: cognitive (6 items), behavioral (4 items) and collaborative (4 items) techniques.

Results: Clinicians practiced an average of 9y (SD = 6.5; range: 1-30y). Most (95% LPs, 84% MAs) indicated having received training in CBT in graduate school and some (64% LP, 40% MAs) on internship. Attitudes toward EBPs were positive (M = 3.74, SD = .54 on a 4-point scale). Receiving CBT training on internship was weakly associated with a more positive attitude toward EBPs (r₍₂₂₀₎ = .19, p = .005). Most participants (80%) reported using cognitive and collaborative techniques with >70% of their patients, but fewer (19%) reported the same for behavioral techniques. Similarly, most participants ( >78%) reported using cognitive and collaborative techniques to a “considerable” or “extensive” degree, but fewer (41%) reported the same for behavioral techniques. Multivariable regression was used to regress license, years practiced, receipt of CBT training on internship, and attitudes about EBP (EBPAS) onto the FA and QA to behavioral, cognitive, and collaborative techniques. Years of practice, having received CBT training on internship, and EBPAS were independently associated with greater FA and QA to behavioral skills (p’s < .03).  EBPAS scores were independently associated with greater FA and QA to cognitive skills (p’s < .01). Having a MA level license (vs. LP) was independently associated with greater FA and QA to collaborative skills (p’s < .05). An exploratory mediation analysis revealed a significant indirect association of receiving CBT training on internship with FA (effect = .10, 95% CI: .01, .22) and QA (effect = .08, 95% CI: .01, .18) to behavioral skills via increased EBPAS.

Conclusion: Even among providers endorsing high agreement with EBP, behavioral techniques are used infrequently when treating EDs. Providers who received CBT training on internship are more likely to use behavioral skills, and this may partially due to a more favorable attitude toward EBPs.