Training in cognitive behavioral therapy in psychiatry residency: an overview for educators.

Embregts (2009) wrote a guide for teachers who run psychiatry residency programs. The paper lists what residents must learn to meet national CBT standards. It also flags two big roadblocks: heavy caseloads and cultural mismatch between therapist and patient.

The review gives no patient outcome data. Instead it maps the gap: programs know CBT is required, but few show how to fit training into 80-hour weeks. Cultural issues, like language barriers, make the gap wider.

Unwin et al. (2016) extends Embregts (2009) by testing CBT in a real under-served group. Their review of 11 small studies shows CBT is doable for adults with mild ID and may ease depression. The same cultural and workload barriers noted in 2009 appear again.

Marrus et al. (2023) updates the story. Their survey finds residents still get almost zero autism/ID training. Together the three papers form a timeline: 2009 calls for better CBT teaching, 2016 proves CBT works in ID, 2023 shows the teaching still has not arrived.

Piazza et al. (2021) and Winett et al. (1991) give the “how.” Both used behavioral skills training—video models and rehearsal—to turn trainees into competent staff. Their positive data contrast with Embregts (2009), which only describes what should happen, not how to make it happen.

If you consult in medical settings, push for brief BST modules instead of long lectures. Show a 5-minute CBT clip, have residents practice with an adult ID client, give instant feedback. The same video-plus-rehearsal package that works for RBTs can fit into a 30-minute lunch break and survives heavy caseloads.