Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?

Bjaastad, Jon Fauskanger; Wergeland, Gro Janne; Haugland, Bente Storm Mowatt; Gjestad, Rolf; Havik, Odd E.; Heiervang, Einar; Öst, Lars‐Göran

doi:10.1002/cpp.2321

Cited by 14 publications

(8 citation statements)

References 48 publications

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“…We found significant overlap between adherence and competence, which is consistent with previous studies with this instrument (Bjaastad et al, 2018;Harstad et al, 2021). However, other studies focused on CBT for youth anxiety have found less overlap (rs 0.55-0.65; McLeod et al, 2018).…”

Section: Discussionsupporting

confidence: 91%

“…Previous research has found correlations between adherence and competence ranging from 0.30 (Carroll et al, 2000) to 0.96 (Barber et al, 2003). The correlations tend to be higher when the same coders score adherence and competence (e.g., Barber et al, 2003;Bjaastad et al, 2018) as opposed to when independent coders score the two components (e.g., McLeod et al, 2018). Our findings suggest that it may be difficult, even for expert coders, to distinguish between adherence and competence.…”

Section: Discussionmentioning

confidence: 41%

“…In light of a recent study indicating school health services may reach youth with elevated anxiety symptoms who otherwise do not receive help (Husabo et al, 2020), there are potential benefits of delivering indicated anxiety prevention in schools. As group (Bjaastad et al, 2018;Harstad et al, 2021), this suggests that novice CBT providers can achieve treatment fidelity when training and supervision is provided. Our findings further indicate that such efforts may be even more successful when the design of the program matches available providers' training and experience (Lyon & Koerner, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found that higher adherence (Hogue et al, 2008;Podell et al, 2013) or higher competence (Podell et al, 2013) predict improvements in clinical outcomes. For example, a study of CBT for anxiety in community mental health clinics (hereafter called community clinics) found that higher adherence predicted improved clinical outcomes, and that competence among clinicians with two years of CBT training predicted improved clinical outcomes (Bjaastad et al, 2018). Yet most studies have found no significant prediction by adherence (Hartnett et al, 2016;Heywood & Fergusson, 2016;Liber et al, 2010;Overbeek et al, 2013;Southam-Gerow et al, 2021) or competence (Garner et al, 2012;Hogue et al, 2008;Southam-Gerow et al, 2021) on clinical outcomes.…”

Section: Treatment Fidelitymentioning

confidence: 99%

“…Competence items are scored on a 0 to 6 scale reflecting the level of skills: 0 (Poor skills) to 6 (Excellent skills). Consistent with prior use of the CAS-CBT with group programs, both facilitators' behaviors were considered when producing scores on each item (see Bjaastad et al, 2018). For each session, an Adherence subscale score was produced by averaging the six adherence items, and a Competence subscale score was produced by averaging the four competence items.…”

Section: Adherence and Competence Measurementioning

confidence: 99%

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Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

Husabø

Haugland

McLeod

et al. 2021

School Mental Health

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To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Fidelitymentioning

confidence: 99%

Section: Adherence and Competence Measurementioning

confidence: 99%

See 3 more Smart Citations

Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

Husabø

Haugland

McLeod

et al. 2021

School Mental Health

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Predicting fidelity and treatment outcomes in savoring interventions among mothers of young children

Borelli,

Perzolli,

Kerr

et al. 2024

Infant Mental Health Journal

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Savoring impacts parents’ emotions and parent–child relationship quality. Using data from a randomized controlled trial (N = 164 mothers of 18–27‐month‐olds, 37 interveners) conducted with a community sample in the United States, this study examined predictors of fidelity and treatment outcomes across two savoring preventative interventions (relational savoring and personal savoring). Treatment outcome indicators were selected from a battery administered immediately post‐intervention (maternal closeness to child) and at a 3‐month follow‐up (maternal sensitivity, reflective functioning). We examined whether intervener education level (bachelor's degree/no bachelor's degree) predicted fidelity (Research Question 1), whether intervener education level predicted treatment outcomes (Research Question 2), and whether fidelity predicted treatment outcomes (Research Question 3). In many cases, intervener education background was not related to fidelity or treatment outcome; however, interveners without bachelor's degrees showed greater adherence to the protocols on some scales (higher positivity, higher secure base, higher calm matching) and sessions with these interveners were associated with greater increases in maternal sensitivity. Regardless of the intervener education level, redirecting attention to the positive and calmly matching participants’ tone were associated with higher maternal reflective functioning, and higher secure base scores were associated with greater closeness. Findings have implications for the training and implementation of prevention programs for parents.

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Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test

van Thiel,

de Jong,

Misset

et al. 2024

J Clin Psychol

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ObjectivesThe therapist‐facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS‐scoring leads to more differentiation in measuring therapists' interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses.MethodUsing secondary data analysis, 93 therapists were exposed to seven FIS‐clips. Responses of therapists using the original and the extended FIS scoring were rated.ResultsThree factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists.ConclusionUsing the revised and extended FIS‐scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.

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Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?

Abstract: Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area.

Cited by 14 publications

References 48 publications

Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety

Predicting fidelity and treatment outcomes in savoring interventions among mothers of young children

Determining differences between therapists using an extended version of the facilitative interpersonal skills performance test

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