Implementing cognitive behavioral therapy for psychosis: An international survey of clinicians' attitudes and obstacles.

Objective: This study aimed to better understand the implementation of cognitive behavioral therapy for psychosis (CBTp) by exploring the impact of clinicians' attitudes toward CBTp within the Theory of Planned Behavior framework (i.e., by considering attitudes, behaviors, intention, and social norms) as well as perceived obstacles and response to proposed solutions. Method: One hundred forty-two clinicians from 2 sites in Canada and 1 site in Australia answered an online survey involving both Likert scales and open-ended questions. The role of attitudes, social norms, and behavioral control (i.e., freedom to decide or act) on intention of offering CBTp delivering CBTp were analyzed using linear and logistic regressions. Sites were compared using analysis of variance. Reponses to perceived obstacles were thematically analyzed. Results: Results were similar across settings. Entered together in the model, attitudes, social norms, and behavioral control were significant in predicting the intention of offering CBTp, F(3, 125) = 38.49, p < .001, with 49% of the variance explained, although behavioral control did not significantly contribute to the model. CBTp training (odds ratio = 0.23, confidence interval = 0.06-0.58) and social norms (odds ratio = 0.79, confidence interval = 0.68-0.93) significantly predicted CBTp delivery. Six themes that emerged regarding perceived obstacles are provided. Training, supervision, and local support were the most frequently endorsed solutions. Brief or modular CBTp and group or online delivery were also positively endorsed. Conclusions and Implications for Practice: Clinicians' individual and collective attitudes should be targeted by more and better training to increase their delivery of CBTp. Given organizational barriers, CBTp-informed interventions warrant further investigation.