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.
cognitive model of social phobia has been extensively evaluated in adults. However, very little data is available on the applicability to social anxiety in adolescence. This study examines the model's applicability in a large adolescent sample. 581 students (aged 14-20) completed questionnaires assessing social anxiety, depression, and variables of the cognitive model (namely safety behaviors, negative social cognitions and social attitudes, self-focused attention, recurrent self-images, pre-and post-event processing). The results revealed that high and low socially anxious youths differed significantly on all cognitive variables. Sequential regression analysis indicated that social attitudes, social cognitions, safety behaviors, and self-imagery were predictive for social anxiety, after controlling for depression and gender. Additionally, a path analysis model examining the relationships between the cognitive variables supported the model's applicability, yielding differential moderating effects of gender. The cognitive model is at least partly applicable to adolescent social anxiety and it might be useful to develop a cognitive treatment for this population.
BITE supervision positively influences the therapeutic alliance and therapeutic competencies during cognitive-behavioural therapy. A supervision format that more directly addresses therapeutic processes is more effective in improving those processes than an indirect supervision format. Pre-treatment differences between therapists might explain the superiority of BITE supervision. BITE supervision can be considered a safe intervention.
Clinical implications Treatment failure is associated with a lower therapeutic alliance in cognitive-behavioural treatment. Therapeutic alliance seems to be an important precondition for the adherent and competent implementation of therapeutic techniques. Therapeutic alliance should be monitored during psychotherapeutic treatment. Cautions or limitations Results are limited to cognitive-behavioural therapy and may not be representative for other treatment approaches. Process analyses are based on highly standardized randomized controlled trials and may not be generalizable to routine care.
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