Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills Linda A. Dimeff a, * , Kelly Koerner b , Eric A. Woodcock a , Blair Beadnell c , Milton Z. Brown d , Julie M. Skutch a , Andrew P. Paves a , Alissa Bazinet a , Melanie S. Harned a a Behavioral Tech Research, Inc., Seattle, WA, USA b Evidence-Based Practice Institute, Seattle, WA, USA c University of Washington, Seattle, WA, USA d California School of Professional Psychology at Alliant International University, San Diego, CA, USA Keywords: Dissemination Empirically-supported treatments Training Dialectical behavior therapy abstract This study evaluated the efficacy of three methods of training community mental health providers (N ¼ 150) in Dialectical Behavior Therapy skills, including a written treatment manual; an interactive, multimedia online training (OLT); and a two-day instructor-led training workshop (ILT). A hybrid design was utilized that incorporated aspects of efficacy and effectiveness trials. Assessments were completed at baseline, post-training, and 30- and 90-days following training. The results indicate that learner satis- faction with the training was highest in OLT and ILT, and both resulted in significantly higher satisfaction ratings than the manual. OLT outperformed ILT and the manual in increasing knowledge of the treatment, whereas ILT and the manual did not differ. All three training methods resulted in comparable increases in clinicians’ ability to apply course content in clinical simulations. Overall, the results provide strong support for the efficacy of technology-based OLT methods in disseminating knowledge of empirically supported treatments to community mental health providers, suggesting that OLT may be a high-quality, easily accessible, and affordable addition to traditional training methods. Ó 2009 Published by Elsevier Ltd. Despite increasing attention to the need for evidence-based practice (EBP) in mental health treatment (e.g., APA Presidential Task Force on Evidence-Based Practice, 2006; Insel, 2009; New Freedom Commission, 2003) and the growing number of available empirically supported treatments (ESTs), ESTs continue to be widely underutilized in routine clinical practice. The considerable gap between research and practice has been labeled the ‘‘dissem- ination problem’’ (Bebbington et al., 2000a; Bebbington et al., 2000b; Kessler et al., 2003; Marks, 2004) and numerous barriers to successfully disseminating ESTs have been identified (Addis, 2002; Barlow, Levitt, & Bufka, 1999; Fixsen, Naoom, Blase, Friedman, & Wallace, 2005; Shafran et al., 2009; Street, Niederehe, & Lebowitz, 2000). One of the most common barriers to the dissemination of ESTs is the lack of effective training opportunities available to treatment providers (e.g., Weissman et al., 2006). At present, standard methods of training community mental health providers in ESTs include the distribution of therapy manuals for self-study and/or brief (e.g., half- to two-day) instructor-led trainings (ILTs). Such training methods have been widely evaluated in medical settings and have not been found to effectively change the behavior of primary care providers (Sohn, Ismail, & Tellez, 2005). Although less research has examined the efficacy of these training methods for psychological treatments, the available data suggest that both therapy manuals and ILTs are likely to improve clinicians’ knowledge of ESTs, but are less likely to change clinician behavior or impact client outcomes (Miller & Mount, 2001; Miller & Rollnick, 1991; Miller, Yahne, Moyers, Mar- tinez, & Pirritano, 2004). Various technology-based training methods, such as Web-based or online training (OLT), have been proposed as alternatives to these standard training methods and are suggested to offer a number of advantages for disseminating ESTs (Weingardt, 2004). In contrast to therapy manuals, OLT can elicit greater learner engagement via dynamic, interactive designs and the provision of realistic models of simulated therapist–client interactions. Similarly, OLT offers several advantages over ILTs such as allowing learners to progress at their own pace, individually tailoring the course content to specific learner needs, and extend- ing the availability of high-quality training to clinicians who live in rural areas or otherwise have limited access to in-person ILTs (Weingardt, 2004). * Corresponding author. Tel.: þ1206 675 8588x103; fax: þ1206 675 8590. E-mail address: ldimeff@btechresearch.com (L.A. Dimeff). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2009 Published by Elsevier Ltd. doi:10.1016/j.brat.2009.07.011 Behaviour Research and Therapy 47 (2009) 921–930