2 - (SYM 25) Patterns of CBT Strategy Use and Treatment Adaptation After Training and Implementation in Routine Care Treatment Settings

While there has been considerable effort to implement CBT in routine care treatment settings, less is known about how it is delivered within routine care. This study uses data from a larger study focused on methods of assessing treatment fidelity in routine care settings to identify modifications made to CBT and commonly used CBT elements in a mix of private practice and community mental treatment health settings after initial training and implementation (Calloway et al., 2025). Data were drawn from a sample of 34 therapists (mean age=49, SD=12; 62% female, 52% White; 61% PhD-level) who had previously received CBT training and consultation. Recordings of therapy sessions (n=268) from 73 patients (mean age=41, SD=16; 38% White; 49% female; 42% public insurance) were rated using the Cognitive Therapy Rating Scale (CTRS), a checklist of common CBT strategies, and a checklist of possible adaptations. Relatively few fidelity-inconsistent adaptations were identified, perhaps due to the flexible nature of CBT. The most common adaptations were format changes (e.g., telehealth, phone sessions; 13%); removing elements (e.g., agenda, homework; 9%), and changing session length (4%). The mean competence score was 37.18 (SD =8.45, range was 9.9–55.0), below the conventional competence cutoff score of 40 on the CTRS. CBT worksheets were used in 57% of the sessions. Additional analyses will describe patterns of use of specific CBT strategies and self-reported use of CBT strategies and adaptations. Implications for training, implementation, and sustainment of CBT in routine care settings will be discussed.