Several studies have demonstrated a positive relationship between competence and outcome in CBT for depression but studies of CBT for anxiety disorders are lacking. The present study explores the relationship between competence and outcome in cognitive therapy (CT) for social anxiety disorder, using hierarchical linear modeling analyses (HLM). Data were drawn from a multicenter randomized controlled trial. Five trained raters evaluated videotapes of two therapy sessions per patient using the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP). Overall adherence to the treatment manual and patient difficulty were also assessed. Patient outcome was rated by other assessors using the Clinical Global Impression Improvement Scale (CGI-I) and the Liebowitz Social Anxiety Scale (LSAS). Results indicated that competence significantly predicted patient outcome on the CGI-I (β = .79) and LSAS (β = .59). Patient difficulty and adherence did not further improve prediction. The findings support the view that competence influences outcome and should be a focus of training programs. Further research is needed to compare different ways of assessing competence and to understand the complex relationships between competence and other therapy factors that are likely to influence outcome.
The aim of the study was to compare the reliability and validity of adherence and competence judgments of four raters, based on session segments on the one hand and on entire sessions on the other. The global adherence/competence judgments based on the middle section of 34 therapy sessions demonstrated satisfactory interrater reliability (ICC=.81/.71) and the highest correlations with therapy outcome (r=.55/.45). These results were comparable with judgments based on entire therapy sessions. However, the reliability of specific aspects of adherence and competence was higher when judgments were based on the entire session. The implications of these results are important in terms of reducing time and costs associated with the judgment process.
Die Sicherung und Überprüfung der Behandlungsintegrität stellt eine essenzielle Voraussetzung für Wirksamkeitsanalysen in der Psychotherapieforschung dar. Die Behandlungsintegrität liefert wichtige Hinweise darüber, ob eine Behandlung so durchgeführt wurde, wie es intendiert war. Es lassen sich 3 unterschiedliche Aspekte der Behandlungsintegrität unterscheiden. Diese sind Adhärenz, Differenzierbarkeit und Kompetenz. Die vorliegende Arbeit gibt Empfehlungen zur Implementierung, Messung und Evaluation der Behandlungsintegrität. Zudem wird eine Übersicht über empirische Befunde gegeben, die einen Bezug zwischen Behandlungsintegrität und Behandlungserfolg herstellen. Es wird deutlich, dass das methodische Vorgehen, insbesondere bei Messung und Evaluation, heterogen und somit die Vergleichbarkeit der Ergebnisse erschwert ist. Dennoch findet sich für viele Studien ein direkter oder indirekter Zusammenhang zwischen Behandlungsintegrität und Behandlungserfolg. Bei nachfolgenden Studien sollten die vorliegenden Empfehlungen zur Implementierung, Messung und Evaluation der Behandlungsintegrität stärker berücksichtigt werden, um eine bessere Vergleichbarkeit der Studien zu ermöglichen.
BackgroundCognitive-behavioral therapy (CBT) is generally known to be efficacious in the treatment of social phobia when applied in RCTs, namely when the treatment manual is based on the Clark-Wells approach. However, little is known about the efficacy of manualized treatments in routine clinical practice (Phase IV of psychotherapy research). The present study (SOPHO-PRAX) is a continuation of a large multicenter randomized clinical trial (SOPHO-NET) and analyzes the extent to which additional training practitioners in manualized procedures enhances treatment effect.Methods/designThirty-six private practitioners will be included in three treatment centers and randomly designated to either training in manualized CBT or no specific training. The treatment effects of the therapies conducted by both groups of therapists will be compared. A total of 162 patients (n = 116 completers; n = 58 per condition) will be enrolled. Liebowitz Social Anxiety Scale (LSAS) will serve as primary outcome measure. Remission from social phobia is defined as LSAS total ≤30 points. Data will be collected at treatment begin, after 8, 15, and 25 sessions (50 min each), at treatment completion, as well at 6 and 12 months post-treatment.DiscussionThe present CBT trial combines elements of randomized controlled trials and naturalistic studies in an innovative way. It will directly inform about the incremental effects of procedures established in a controlled trial into clinical practice. Study results are relevant to healthcare decisions and policy. They may serve to improve quality of treatment, and shorten the time frame between the development and widespread dissemination of effective methods, thereby reducing health cost expenditure.The results of this study will not only inform about the degree to which the new methods lead to an improvement of treatment course and outcome, but also about whether the effects of routine psychotherapeutic treatment are comparable to those of the controlled, strictly manualized treatments of the SOPHO-NET study.Trial registrationClinicalTrials.gov identifier: NCT01388231. This study was funded by the German Federal Ministry of Education and Research (SOPHO-NET: BMBF 01GV0607; SOPHO-PRAX: BMBF 01GV1001).
As expected, the implanatation of an ICD is associated with high acceptance and increased life quality in about 3/4 of patients. However, there is a subgroup of patients (20-30%) who have difficulties and the measured dimensions remain at elevated levels after implantation, thus, indicating that these patients probably need competent psychological help.
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