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Clinical Round Tables

Interventions and Care Delivery Models in the Context of Resource Limitations

Expanding Access to High-Quality CBT: Preserving Mechanisms of Change Across Care Settings—Lessons from TEAM-CBT

Clinical Round Table 9 - Expanding Access to High-quality CBT: Preserving Mechanisms of Change Across Care Settings—lessons from TEAM-CBT

Friday, June 26, 2026
4:00 PM - 5:30 PM PDT
Location: Yerba Buena Salon 1, B3 Level
Earn 1.5 Credit
Keywords: Underserved Populations, Change Process / Mechanisms, Education and Training
Level of Familiarity: Basic to Moderate
Recommended Readings: Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017).
A tipping point for measurement-based care. Psychiatric Services, 68(2), 179–188.
https://doi.org/10.1176/appi.ps.201600439,   Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R., & Wright, B. (2018).
Transparency about the outcomes of mental health services (IAPT). Behaviour Research and Therapy, 111, 18–26.
https://doi.org/10.1016/j.brat.2018.10.001,   Kazdin, A. E. (2007).
Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27.
https://doi.org/10.1146/annurev.clinpsy.3.022806.091432,   ,  
Expanding access to cognitive behavioral therapy (CBT) while preserving clinical effectiveness remains a central challenge for mental health systems worldwide. Stepped-care, group, digital, and community-based models increase reach, yet concerns persist that CBT impact may weaken if core change processes are not preserved as intensity and resources decrease. This clinical roundtable examines TEAM-CBT as a model for addressing this tension.
TEAM-CBT is a fractal clinical framework in which the same core change processes—Testing, Empathy, Analysis of Resistance, and Methods—are preserved across levels of care, delivery formats, and training contexts. This structural fidelity to mechanisms of change supports effective, accessible CBT delivery across diverse settings and resource levels.
Panelists will present real-world applications of TEAM-CBT across multiple care settings, illustrating how the same change processes are maintained as scale and intensity vary. Examples include low-intensity CBT (LICBT) initiatives; a grassroots book-club model that extends CBT skills beyond traditional clinical settings; delivery of TEAM-CBT in a safety-net clinic; and a training-group model that builds workforce capacity while reinforcing outcome-focused clinical practice.
Presenters will highlight clinical outcomes including symptom improvement, engagement, and retention, with particular attention given to how routine outcome monitoring and explicit work with resistance support sustained participant involvement in settings where resources are limited.
The roundtable will explore how preserving mechanisms of change—rather than rigid protocols—sustains clinically meaningful impact across contexts. Discussion will focus on identifying which elements of CBT must remain invariant to preserve effectiveness, and which can flex to meet local resource constraints.
This session offers clinicians, supervisors, and system leaders practical, transferable lessons for expanding access to high-quality CBT without sacrificing therapeutic impact.

Learning Objectives:

  • Describe how TEAM-CBT preserves core mechanisms of change across low-intensity, group, and training settings.
  • Identify which CBT elements must remain invariant to maintain clinical effectiveness when care is delivered at scale.
  • Explain how measurement-based care and resistance work support engagement and retention in resource-limited settings.
  • Apply mechanism-focused principles to expand access to CBT without compromising clinical effectiveness.
  • Inform system-level decisions about adapting CBT delivery across diverse care settings and resource levels.