Therapist adherence to a treatment manual influences outcome and dropout rates: Results from a multicenter randomized clinical CBT trial for panic disorder with agoraphobia

Abstract

Therapist adherence has been shown to contribute to the effectiveness of treatment interventions. The role in a patient's decision to drop out of treatment, however, is unknown. This study investigates whether therapist adherence affects clinical outcome and the risk for dropout. Patients diagnosed with panic disorder with agoraphobia (N = 265) were treated in one of two CBT variations: with (T+) and without (T-) explicit therapist-guided exposure. Significant associations between lower levels of adherence and symptomatic improvement were observed in treatment completers in the T-condition and dropouts in T+ condition suggesting that adherence-outcome relations are potentially contributed by patient and treatment characteristics. Moreover, our results propose that patient related difficulties with exposure procedures may lead to lower adherence and dropout.

Optimizing exposure-based CBT for anxiety disorders via enhanced extinction: Design and methods of a multicentre randomized clinical trial

“…The treatment manual is modular and highly structured by session goals and verbatim text suggestions for therapists. A comparable manual has been tested in RCTs and is widely used, treatment integrity and therapist compliance are high (Hauke et al, ). All therapy sessions are video recorded to monitor adherence by random video inspection (5% of sessions).…”