Trial Search Results

Innovative Methods to Assess Psychotherapy Practices (imAPP)

This project compares two methods of assessing the quality of cognitive behavioral therapy (CBT) that do not involve directly observing sessions: 1) adherence checklists embedded in clinical notes, and 2) rating the quality of worksheets that are completed with therapist guidance during sessions. It also examines whether ratings of worksheets completed on a mobile app are reliable and valid quality measures. This information can inform strategies to monitor and enhance CBT quality, which can ultimately improve the quality of care and clinical outcomes.

Stanford is currently accepting patients for this trial.

Lead Sponsor:

Palo Alto Veterans Institute for Research

Collaborator: National Institute of Mental Health (NIMH)

Stanford Investigator(s):


  • Behavioral: Cognitive Behavioral Therapy


Inclusion Criteria:

A. Clinician eligibility:

   - Private practice or employment at an agency at which the administration agrees to
   allow the recruitment and participation of their providers in research related

   - English Speaking

   - No anticipated plans to leave their current agency for at least 18 months

   - Willingness to allow their CBT sessions, worksheets, surveys, and interview data, and
   clinical notes to be used for research purposes

   - Carry a caseload that typically includes patients who experience depression, anxiety,
   or PTSD, with whom they regularly conduct individual therapy sessions and/or capacity
   to increase the proportion of such patients (e.g., clinic sees a substantial number of
   individuals with PTSD or depression)

   - Must be trained (worksheet or web-based training and consultation) or in training for
   Cognitive Processing Therapy (CPT) for PTSD or CBT for depression or anxiety that uses
   worksheets Does not include CBT-i Can include aspects (i.e., worksheets) of CBT for
   substance use as long as depression or anxiety is primary diagnoses

   - Must anticipate at least 3 eligible patients

   - Must be willing to record sessions and provide worksheets and symptom measures to the

   - Must have computer and internet access

   - Must be willing to use a mobile app on a tablet or mobile device

B. Patient eligibility:

   - Must be 18 yrs. of age or older

   - Experience one or more of the following (both a diagnosis and cut off score):

Clinician diagnosis of primary PTSD (PTSD-Checklist-5 score of 33 or more) Depressive
disorder (e.g., major depressive disorder, dysthymia; PHQ of 10 or above) Or an Anxiety
Disorder (Beck Anxiety Disorder score of 22 or above)

   - Note that if a patient has a score close to the cut-off score, it's up to the
   therapist digression

      - Must be willing to allow the team to collect session recordings, measures, notes
      and worksheets

      - Must be able to read and write at a sixth-grade level or above

      - Able to participate in sessions conducted in English, or Spanish (if working with
      bilingual clinicians in community or private practice)

      - Must be willing to engage in CBT/CPT

      - Therapist considers the treatment with the individual patient to be "mostly" CBT
      or CPT

Cannot have*:

- Imminent risk of suicide or homicide (requiring hospitalization) that require immediate
treatment In need of detoxification (can be enrolled when substance abuse treatment is not
the primary treatment target) Active psychosis or manic episode unless well controlled by
medication and not the primary focus of treatment Cognitive impairments that preclude any
participation in therapy

C. Administrator eligibility:

   - Must have a support or managerial/supervisory position at the clinic(s) from which A
   and B are being recruited from

   - Must also be willing to complete a packet of study measures/partake in an interview

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study


Now accepting new patients

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Shannon Wiltsey-Stirman, Ph.D.
650-493-5000 Ext. 20007