Implementing CBT and FIT in Primary Care: Effects on Fidelity, Engagement, Goal-Directed Behaviour and Self-Efficacy

Abstract Primary mental health care services typically offer a range of treatments. According to the principles of national health care services in Norway it is essential to ensure that treatments adhere closely to evidence-based practices. The aim of this implementation study was to investigate whether a training program in cognitive behavioural therapy (CBT) and feedback informed treatment (FIT) increased therapist adherence and competence to these interventions, and whether these changes were maintained across time. In addition, we investigated whether there was an association between treatment adherence and work engagement, self-efficacy and goal-directed behaviour. Therapists in mental health and addiction services in the municipality of Drammen, Norway were invited to take part in the training program. Over a 4 year period from 2020 to 2023 the therapists responded on a web-based survey and self-reported their fidelity using Cognitive Therapy Adherence and Competence Scale and Feedback Readiness Index and Fidelity Measure. The results showed a significant increase in fidelity after the first year of the implementation and this was maintained both the practice of CBT and FIT. We also found an increase in factors considered important for implementation such as work engagement, goal-directed behaviour and self-efficacy, although these changes were not maintained over time. Additionally, we found an association between the three factors and fidelity. This study indicates that consistently applying a structured implementation approach is effective for both developing and sustaining therapeutic competence in primary care.