Can trained peers deliver Cognitive Behavioral Therapy?

In a recent post, I explained my “why” behind the development of my peer support training program that provides mental health and well-being supports to those who would not otherwise have access. 

The “why” behind peer support training

In the post, I said that my “why” was based on four realizations:

1. Some people want help with their own mental health and well-being but hesitate to see a licensed psychologist.
2. Another group of people have the skills and want to help others achieve greater mental health and well-being, but they hesitate to embark on the lengthy schooling process necessary for becoming a licensed psychologist.
3. Cognitive behavioral therapy (CBT) works in a variety of situations.
4. Few peer support training programs explicitly include CBT principles in their curriculum.

But…can peers lead CBT sessions?

Right away, I received one very important question from a colleague on LinkedIn: Can trained peer counselors provide Cognitive Behavioral Therapy?

That question deserves a thoughtful response.

First, I responded by saying this, in part: “For clarity, I want to add that I never suggest that peer support replaces the work of a licensed provider. I only encourage trained peers to implement some of the principles of CBT where appropriate, and the training makes it clear when referrals may be necessary. We don’t suggest that peer supporters diagnose or treat, only support.”

And I'd like to add a portion of another comment in support of peers and CBT that quite nicely summarizes how I feel: "While we may not be keen on or clinically qualified to deliver CBT in a formal clinical sense, having peers trained in basic CBT practices could present an opportunity for us to deliver these skills in a. more relatable and understanding way to our peer that if we were strictly clinical."

Research on peer-directed CBT

My second response to my colleague’s thoughtful question was to highlight the research.

I’ve read several research articles about the efficacy of peer-delivered CBT. For example:  

• Undergraduate students with social anxiety benefitted from internet-based, peer-lead CBT treatment in Bautista et al. (2021).
• Peer specialists delivered computer-based CBT to improve symptoms of depression in a group of 330 Veterans in Pfeiffer et al. (2020).
• Peer specialists delivered Cognitive-Behavioral Social Skills Training to Veterans with serious mental illness in Chinman et al. (2019) and showed statistically significant improvement in four outcomes (symptoms, hope, defeatist attitudes, skill learning).
• Through an app, ChatBots effectively delivered web-based CBT to college students who self-identified as having symptoms of anxiety and depression in Fitzpatrick et al. (2017).
• Peer support specialists delivered web-based CBT targeting PTSD symptoms and hazardous drinking to combat veterans who experienced significant improvements in PTSD, quality of life, resiliency, and coping post-treatment in Possemato et al. (2019).
• Peer support specialists led group CBT to address postpartum depression effectively in Babiy et al. (2023). 
• Women who have recovered from postpartum depression (peers) effectively reduced symptoms of postpartum depression and anxiety through a CBT intervention in Amani et al. (2021).

I also quoted Judith Beck’s position where she advocated for alternative pathways of CBT delivery. In her 2023 article, she said,

“A tremendous amount of research is being done into new and creative ways to provide CBT interventions to individuals who have traditionally been unable to access evidence-based mental health care due to cost, lack of trained clinicians, or stigma surrounding seeking mental health care. Researchers have had success in implementing CBT with individuals in low-resourced areas by training nonprofessionals and peers to deliver CBT in a range of novel settings.”

Back to my “why”

I love questions and comments that make me think and revisit my “why.” My colleague did just that by asking if peers could deliver CBT.

It prompted me to look once again at the current research and examine the soundness of my “why.”

Is it still a good idea to provide access to mental health care to those who had been “unable to access evidence-based mental health care due to cost, lack of trained clinicians, or stigma surrounding mental health care?"

Is it still a good idea to train “nonprofessionals and peers to deliver CBT in a range of novel settings?”

The research and Judith Beck seem to point to a resounding “YES.”

In praise of peer support and CBT

Peer support specialists can implement the principles of CBT. It's been implemented in a variety of settings, from diabetes health care to PTSD support, recovery, reentry, and support for anxiety and depression, and the research demonstrates its effectiveness.

Peer supporters serve as role models of recovery, assist with navigating healthcare systems, and promote treatment engagement. The literature supports peers delivering CBT to increase positive outcomes in a variety of populations.

And yes, while I do not suggest that peer support specialists replace mental health professionals or that peer supporters should act in a clinical role, I do promote the idea that peers are qualified to use their lived experience to implement basic CBT practices in a relatable and understandable way.

Want to be a peer support specialist who is trained to deliver CBT principles? Take our online course Peer Support Specialist Training and expand CBT beyond the traditional therapy office to individuals who have traditionally been unable to access evidence-based mental health care. We’ll teach you how to recognize and address negative thought processes and behaviors and help your clients thrive. Register today.