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theses

Research investigating feasible, evidence-based strategies for transferring empirically-validated treatments into routine clinical settings is needed to bridge the implementation gap. This study evaluated the implementation of cognitive behavioral guided self-help (CBTgsh) for recurrent binge eating in a university counseling center, using a train-the-trainer (TTT) model situated within the Core Implementation Components framework (Fixsen, Blase, Naoom, & Wallace, 2009). An organizational stakeholder served as “trainer” and staff therapists as “trainees.” This study also served to 1) test the bounds of effectiveness of both CBTgsh and the second cascade of the TTT model and 2) respond to a service request by university community partners for assistance in instituting a sustainable program of CBTgsh within a counseling center after the Zandberg and Wilson (2012) trial. After receiving expert-led training in CBTgsh, the designated trainer subsequently trained and supervised interested staff therapists (n = 7) to implement the treatment. Consultation was provided to the trainer throughout the two years of study implementation. Clients were 12 students (83.3% female) presenting with recurrent binge eating at a university counseling center; diagnoses included binge eating disorder (50%), eating disorder not otherwise specified, and one case of bulimia nervosa. Given study limitations, results should be considered pilot data. Consistent with hypotheses, study therapists implemented treatment with a high level of fidelity to the protocol by the end of Year 2; additionally, study therapists expressed positive attitudes toward manualized treatments, which were unchanged from pre- to post-training. Last observation carried forward intent-to-treat (ITT) analyses indicated statistically significant reductions in recurrent binge eating and depressive symptoms from baseline to post-treatment using weekly-administered assessments of binge eating frequency and depression. Indicators of program sustainability and implementation success evident by study conclusion included embedded twice-yearly CBTgsh trainings at the counseling center as well as the creation of a CBTgsh minor rotation within the predoctoral internship program at the center. Limitations were considerable, and notably included low recruitment and small sample size, low retention (41.7% completers), and low post-treatment assessment completion. Suggestions for guiding future implementation of CBTgsh within similar settings are discussed.

ETD_5852

Ph.D.

Includes bibliographical references

by Julia Anne West

doi:10.7282/T3Q81FP3

ETD doctoral

The author owns the copyright to this work.