International Journal of Science Annals, Vol. 4, No. 1, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa SOCIAL AND BEHAVIORAL SCIENCES. Psychology ORIGINAL RESEARCH The Effect of Cognitive Behavioral Therapy Training Program on Reducing Emotional and Social Distress: Three Years Follow Up AuthorsтАЩ Contribution: A тАУ Study design; Sabra Z. E. I.1 ABCDEFG , Daigham A. I.2 ABCDEFG B тАУ Data collection; C тАУ Statistical analysis; 1 Fayoum University, Egypt D тАУ Data interpretation; 2 Minia University, Egypt E тАУ Manuscript preparation; F тАУ Literature search; Received: 10.05.2021; Accepted: 15.06.2021; Published: 30.06.2021 G тАУ Funds collection Abstract Background and This paper addresses the question: is a brief cognitive behavior therapy training Aim of Study: program enhances psychologistтАЩs skills as reflected in scores on cognitive therapy skills scale and in helping students with emotional and social problems? The aim of the study: to explore the impact of the effect of cognitive behavioral therapy training program on reducing emotional and social distress over 3 years. Material and Methods: Participants are 35 school psychologists (20 females and 15 males) have received intensive cognitive behavior therapy training for 6 days during two weeks followed by one to one supervision in school sittings for three months. Participants completed cognitive behavior therapy scale. Individual and group counseling sessions delivered to male and female (age mean is 13.7 years) students known of emotional and social problems during the current school year. Supervisors wrote a report in the end of three months practice, students and parentтАЩs feedback had collected. Results: Results show that differences between pre and post scores on cognitive behavior therapy scale are statistically significant (t=4.92), supervisors reports and students feedback indicate improving therapeutic skills by the end of three months practice. Conclusions: Cognitive behavior therapy training program has positive influence in enhancing cognitive behavior therapy skills in school psychologists that reflected in providing effective counseling for students with emotional and social problems. Supervision based training optimizing the therapeutic outcome in both individual and group therapy sessions. Follow up of 3 years revealed continuous effect of the training and continuous supervision in improving counseling skills of school psychologists. Keywords: cognitive behavior therapy, emotional problems, social problems, cognitive behavior therapy skills, cognitive therapy scale Copyright: ┬й 2021 Sabra Z. E. I., Daigham A. I. Published by Archives of International Journal of Science Annals DOI and UDC DOI https://doi.org/10.26697/ijsa.2021.1.3 UDC 159.955:37.091.315.7 Conflict of interests: The authors declare that there is no conflict of interests Peer review: Double-blind review Source of support: This research did not receive any outside funding or support Information about Sabra Zizi Elsayed Ibrahim (Corresponding Author) тАУ https://orcid.org/0000- the authors: 0001-8329-9615; zss11@fayoum.edu.eg; Doctor of Philosophy in Psychology, Associate Professor, Department of Psychology, Faculty of Arts, Fayoum University, Fayoum, Egypt. Daigham Abdelmohsen Ibrahim тАУ https://orcid.org/0000-0001-6253-0005; Doctor of Philosophy in Psychology, Associate Professor, Department of Psychology, Faculty of Arts, Minia University, Minia, Egypt. 16 International Journal of Science Annals, Vol. 4, No. 1, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Introduction (Beck, 1967; 1976; 1991; 1993; 1995; 1997; 2005; Beck Psychological services in the governmental schools face et al., 1979; 2004; Clark et al., 1999), but results depend many challenges, since it established in 1990 side to side on the therapistsтАЩ skill and competences (Kazantzis et with the social services (Abousrea et al., 2009; al., 2018). Training could enhance cognitive behavior Sherefeen & Abouhasona, 2011). School psychologistтАЩs therapy skills and enable those psychologists to help jobs were limited to behavioral assessment of emotional students to cope with their emotional and interpersonal and academic problems (Ismael, 2006). School problems. Supervision is essential in learning cognitive psychologists are willing to offer better job by applying behavior therapy. Despite the divergence in systems of the counseling and therapeutic change with students psychotherapy, their goals and varied training practices, who suffered because of emotional, interpersonal, or supervision remains the one component considered academic problems (Yousef, 2009). One of the barriers essential to all (OтАЩDonovan et al., 2011). MillerтАЩs to achieve this goal is preparing the school psychologists hierarchical framework for assessing clinical skill, to be competent in delivering a professional help with ranging from therapistsтАЩ knowledge of CBT (тАЬknowsтАЭ), these problems (Albana, 1990; Elfeky, 1990; Ismael, their practical understanding (тАЬknows howтАЭ), their skill 2006; Kamel, 1990; Taha, 1990; Yousef, 2009). within artificial clinical simulations (тАЬshows howтАЭ), and Psychotherapeutic competence is conceptualized as a their skill within real clinical practice settings (тАЬdoesтАЭ) therapistтАЩs general and treatment-specific knowledge (Muse et al., 2017). In his definition of supervision level, skill level, and values or attitudes while Milne (2009) stated that the formal provision, by implementing therapeutic interventions (K├╝hne et al., approved supervisors, of a relationship-based education 2020). Assessment of psychotherapeutic competences and training that is work-focused and which manages, are essential to training, supervision, clients care, quality supports, develops and evaluates the work of colleague/s control, and lifeтАРlong practice (K├╝hne et al., 2019). (precision). It therefore differs from related activities, Assessment of therapeutic competence may provide such as mentoring and therapy, by incorporating an therapists with formative and summative feedback and evaluative component (precision by differentiation) and may guide self-reflection (Muse & McManus, 2013). by being obligatory. The main methods that supervisors Cognitive behavior therapy (CBT) have been use is corrective feedback on the superviseesтАЩ consistently shown to be effective across a wide range performance, teaching, and collaborative goal-setting of disorders (Ho et al., 2016; Hofmann et al., 2012; (specification). The objectives of supervision are Kobori et al., 2014). Previous CBT training evaluations тАЬnormativeтАЭ (e. g. case management and quality control indicate that traineesтАЩ clinical competence and issues), тАЬrestorativeтАЭ (e. g. encouraging emotional knowledge improve over the training period (McManus experiencing and processing) and тАЬformativeтАЭ (e. g. et al., 2010). Measurement of cognitive behavioral maintaining and facilitating the superviseesтАЩ therapy competency is designed to reveal how well competence (Milne, 2009). therapists deliver CBT, the results of which can serve There is a growing body of literature showing that many important functions in research and clinical therapists receiving supervision have more positive training contexts and has the potential to optimize clientsтАЩ outcomes in therapy (OтАЩDonovan et al., 2011). training and dissemination of CBT (Rozek et al., 2018). The importance of this study in one aspect is that, Cognitive Therapy Scale developed by Young and Beck helping the psychologists to enhance their professional in 1980 for assessing CBT skills (Young & Beck, 1980a; skills in counseling and therapy services. On other 1980b). It is the most established measurement of aspects it enables testing the actual results of the training therapist competence in the context of providing CBT in real life sittings within schools. By giving them the (Weck et al., 2016). opportunities to refine their counseling skills under a This study is interested in investigating how far brief close extended supervision and evaluation of clientтАЩs cognitive therapy training could enhance school outcome from various perspectives. psychologists CBT skills and offer better help for Few studies have examined multiple perspectives (i. e. students known with emotional and social problems. independent observer, supervisor, trainee therapists and School psychologists are capable to help students with patient) of competency evaluation and few studies have their psychological problems, as they spend relatively examined all perspectives together (Rozek et al., 2018). long time with them and know about their strengths and Current study collects data from supervisors, students, weaknesses as well. teachers and parents, which enables considering Adjustment in school environment is very important and multiple feedback of therapy outcome. has a great impact on studentтАЩs overall adjustment and The aim of the study. To explore the impact of the effect psychological health. of cognitive behavioral therapy training program on For the study of psycho-adaptive and psycho- reducing emotional and social distress over three years. maladaptative personality disorders, complexes of psychological and medical methods for diagnosing Materials and Methods mental health are mainly used, which allows revealing Participants and Supervisors psychological peculiarities of the subjects (Melnyk & School psychologists of total number 35 (20 females and Stadnik, 2018). 15 males) with mean age of 31.7 years, average of 5.4 Cognitive behavior therapy is known as an effective years of experience. Table 1 shows participantsтАЩ treatment for many of the psychological problems characteristics. 17 International Journal of Science Annals, Vol. 4, No. 1, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 1 Participants Demographic Data Characteristics Value Total participants 35 15 males Participants by gender ratio 20 females Age mean 31.7 Experience years mean 5.4 Qualifications: - BachelorтАЩs degree 31 - MasterтАЩs degree 2 - PhD degree 2 Two Supervisors participated in the current study is a year. The reports include activity plan, intervention tools Clinical Psychologists (trained in CBT). Supervisor has and evaluation notes. served as trainers in psychotherapy training for 7, and 17 2. Supervisors tasks is to help implementing and to years. Supervisor (1) had 12 years of clinical experience evaluate the following items: and school counseling. He got his PhD degree in - agenda setting: suitable items, feasible agenda; Counseling and Psychological Wellbeing. Supervisor - CBT interventions: appropriate intervention targets, (2) had 23 years of clinical experience and academic choosing suitable interventions, rationale for teaching of Clinical Psychology. interventions, implementing interventions; The study used the following scales: the Cognitive - homework: choosing suitable homework, reviewing Therapy Scale and the Cognitive Behavior Therapy homework, rationale for homework, planning Skills Scale. homework; The Cognitive Therapy Scale (CTS) was developed by - assessing change: choosing suitable measures; Young and Beck (1980), and modified by Blackburn and - effective two-way communication: empathic colleagues (Blackburn et al., 2001; James et al., 2001). understanding, collaboration, client feedback, reflective An Egyptian version of the CTS validated by Sabra summaries. (2017); Sabra and Daigham (2020), contains 11 items Procedures that evaluate specific aspects of therapist competence Participants attend 6 days training in cognitive behavior including agenda setting, dealing with therapy. The training included basics and techniques of problems/questions/objections, clarity of cognitive behavior therapy of Adolescents problems. communication, pacing and efficient use of time, Participants completed Cognitive Behavior Therapy interpersonal effectiveness, resource activation, Skills Scale before and after the training course. reviewing previously set homework, using feedback and A close supervision is established for the first stage summaries, guided discovery, focusing on central implementation in eleven preparatory schools. General cognitions and behaviors, rationale, selecting psycho educational plan for students of these schools appropriate strategies, appropriate implementation of have been set, and individual counseling for students techniques and assigning homework. with emotional and interpersonal problems conducted The CTS uses a 7-point rating scale format: 0 = poor, 1= too. barely adequate, 2= mediocre, 3= satisfactory, 4= good, Feedback from students who received individual and 5= very good, and 6 = excellent. group CBT counseling sessions for emotional and In the current study, the inter-rater reliability of the CTS interpersonal problems collected. Other teachers and mean scores between the two raters was high (0.87). parentтАЩs feedback about those studentsтАЩ behaviors The Cognitive Behavior Therapy Skills Scale (CBTS) collected too. Supervisors reports collected by the end consists of 40 items with 5 points Likert rating scale of of each 3 months. 1= not use it at all to 5= use it most of the times. Alpha Follow up during 36 months to evaluate and enhance the reliability is 0.92 (n=55) and test retest reliability is 0.74 counseling service in the Beni Mazar district primary (n= 20) with good validity indicators (Sabra, 2017). schools. StudentsтАЩ feedback after each session and behavioral observation of class mates included in sessions report Results and Discussion that reviewed by supervisors. CBT training program has positive influence in Supervision is an educational process and, as such, enhancing CBT skills in school psychologists that benefits from using well-established principles that are reflected: known (from other contexts) to improve the likelihood 1. Results of t-test of paired samples, of CBTSS scores of learning (Pilling & Roth, 2014, p. 26): show that there are significant differences between pre 1. Written reports of psychological counseling sessions and post mean scores as shown in Table 2-3. as a part of psychological activity plans during school 18 International Journal of Science Annals, Vol. 4, No. 1, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Table 2 Paired Sample Statistics CBTSS M N SD SEM CBTSS post 168.85 33 27.373 5.211 CBTSS pre 157.76 33 29.933 4.765 Note. CBTSS post тАУ scores on cognitive behavioral therapy skills scale after training; CBTSS pre тАУ scores on cognitive behavioral therapy skills scale before training; M тАУ the mean (average); N тАУ participants; SD тАУ the standard deviation; SEM тАУ the standard error of the mean. Table 3 Results of Paired Sample T-Test (N=33) Paired differences CBTSS T DF Sig. M SD SEM Pair 1, CBTSS post & CBTSS pre 11.091 12.93 2.251 4.927 32 0.000 Note. CBTSS post тАУ scores on cognitive behavioral therapy skills scale after training; CBTSS pre тАУ scores on cognitive behavioral therapy skills scale before training; M тАУ the mean (average); SD тАУ the standard deviation; SEM тАУ the standard error of the mean; T тАУ the t-test statistic; DF тАУ the degrees of freedom; Sig. тАУ significance level. 2. Providing effective counseling for students with Conclusions emotional and interpersonal problems as indicated of Cognitive behavior therapy training program has positive reporting that: influence in enhancing cognitive behavior therapy skills - reduced complaints of studentтАЩs problematic behaviors; in school psychologists that reflected in providing - increasing involvement in counseling activities and effective counseling for students with emotional and sessions; social problems. Supervision based training optimizing - parents reports show that kids became able to listen and the therapeutic outcome in both individual and group conduct calmer communication between each otherтАЩs; therapy sessions. Follow up of 3 years revealed - kids became more comfortable communicating with continuous effect of the training and continuous teachers and adults in their social network; supervision in improving counseling skills of school - kids are more motivated to participate in school psychologists. activities and more likely to follow school rules. Research limitations and recommendations for future 3. Supervision helped in optimizing the therapeutic studies: outcome in both individual and group therapy sessions: - Data collection in this research focused on client out - after 3 years of follow up, supervisor report shows that, come and supervisorsтАЩ reports. Need for collecting data psychological counseling became an established process on superviseesтАЩ competence, that include supervisors in school year activity plan; systematically sampling superviseesтАЩ in-session - more schools became included in CBT counseling behaviour as OтАЩDonovan and colleagues (OтАЩDonovan et systematically. Psychologists became more familiar with al., 2011) recommended. CBT structure and use it in their routine counseling work - Future research should continue to work on validating with students. and refining competency measures in order to enhance 4. Efforts to communicate with students and their training and, allowing for better clientsтАЩ outcomes. families during pandemic are continuing to help students - Future studies needed to replicate these findings with a cope with educational and evaluation method change larger sample and a wider variety of counselorтАЩs since March 2020. experience. 5. Psychologists participated in enhancing awareness and - More tools are needed to improve tele-counseling protection of COVID-19 for students and their families. processes. 6. Psychologists provide brief useful psych education on anxiety symptoms that are widely spread during Acknowledgements pandemic time through telehealth techniques. We would like to express our deepest gratitude to 7. In the beginning of the 2018-2019 school year total of Dr. Ahmed Gamal Alshereef, for his efforts in organizing 105 school psychologist finished the cognitive behavior and supervising activities during the program and the therapy training and were ready to establish the cognitive following 3 year while the CBT counseling was therapy and positive thinking program in all preparatory delivering to students at schools. schools in Beni Mazar district. We would like to express our deepest gratitude to 8. The cognitive therapy and positive thinking program Dr. Yuriy Melnyk for introducing this prestigious Journal considered as a standard psychological activity to us and encouraging us to publish our paper in the programme to be repeated each semester during the time aforementioned Journal. between September 2018тАУMarch 2020. 19 International Journal of Science Annals, Vol. 4, No. 1, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Ethical Approval Preparing Psychologists in Egypt, Technological The study protocol was consistent with the ethical Development and Planning Institute, Cairo guidelines of the 1975 Declaration of Helsinki as University, Giza, Egypt. reflected in a prior approval by the InstitutionтАЩs Human Ho, F. Y., Chan, C. S., & Tang, K. N. (2016). Cognitive- Research Committee. behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: Funding Source A meta-analysis of randomized controlled trials. 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The effect of cognitive behavioral therapy training program on reducing emotional and social distress: three years follow up. International Journal of Science Annals, 4(1), 16тАУ21. https://doi.org/10.26697/ijsa.2021.1.3 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv and in the KRPOCH Publishing Repository https://ekrpoch.culturehealth.org/handle/lib/71 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 21