Incorporating Evidence-Based Interventions in Standard Clinical Practice Takes Grit

Background: Substance use disorder (SUD) remains a pervasive problem in the U.S. and elsewhere. Recent scholarship has explored therapist characteristics and evidence-based intervention (EBI) implementation in an attempt to improve client outcomes. One such construct that has received considerable attention is grit. People with high levels of grit tend to remain determined despite setbacks.

Methods: This cross-sectional study sought to elucidate the relationship of grit to therapeutic alliance and attitudes towards evidence-based interventions in a sample of front-line therapist (n=240) working throughout SUD treatment programs in the Midwest region of the United States. Participants had to have had a clinical caseload in order to be eligible for the study. Managers and supervisors were only eligible to participate if they also were responsible for carrying a clinical caseload. We recruited between six and 55 therapists per agency. We used the Working Alliance Inventory-Short Form as a proxy measure for clinical skill. The 12 items in the measure represent a subset of a more exhaustive list of 36 items previously developed and assesses three dimensions of the working alliance: task, bond, and goal. We used the Short Grit Scale, which assesses perseverance and passion for long term goals at the trait level. The measure contains 8 items, four of which are reverse scored. There are 5 possible responses to each question ranging from not like me at all to very much like me. A composite score is calculated by summing each item and dividing by 8. A score of 1 indicates not at all gritty while a score of 5 indicates extremely gritty.  We used the Evidence-Based Practice Attitudes Scale to measure attitudes towards EBIs. Four subscales are computed from the 15-item scale, which has a 5-point response scale (possible responses range from not at all to a very great extent). The subscales consist of: Appeal, Requirement, Divergence, Openness.

Results: The sample was primarily white (72.1%), female (70.5%), and worked as a provider of direct services (87.1%; 6.6% of the sample was in supervisory roles and 5.0% of the sample was in management). Most of the sample (61.7%) had a master’s degree, 19.8% had a bachelor’s degree, and 8.6% had an associate’s degree. Stepwise linear regression was used to examine the relationship between WAI scores and demographic variables, EBPAS subscale scores, and grit. Grit was found to be positively associated with therapeutic alliance (b=.52, p<.000) and correlated with favorable attitudes towards using proven practice (r=.18, p<.05).

Discussion: Findings suggest that gritty therapists may sustain the use of evidence based interventions in their usual services and have better client outcomes. It should come as no surprise that certain personality traits and attitudes are related to performance as the literature has regularly supported this association. The practical application of these findings is that if SUD treatment services want to increase the likelihood of their patients being treated with up-to-date EBIs, organizational leaders may want to recruit and hire therapists with high grit and openness scores.