Treatment integrity and therapeutic change: Issues and research recommendations.

Perepletchikova, Francheska; Kazdin, Alan E.

doi:10.1093/clipsy.bpi045

Cited by 367 publications

(263 citation statements)

References 97 publications

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“…Therapist compliance with an intended intervention is a prerequisite for understanding the mechanisms of action in psychotherapy treatment (Perepletchikova & Kazdin, 2005). Manual-based interventions facilitate the comparison of therapies on potentially confounding unspecific parameters (Heimberg & Becker, 1994) and ensure tailored treatment elements to optimize the mechanisms of change (Luborsky & DeRubeis, 1984).…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, only White et al (2010) investigated the association between treatment factors and dropout in CBT for patients with panic disorder with agoraphobia (PD/AG) suggesting that adherence did not predict treatment complementation. Based on clinical considerations, the importance of therapist adherence might potentially differ across treatment elements and individual patient requirements (Perepletchikova & Kazdin, 2005). A high anxious patient, for instance, with strong avoidance behavior and thoughts of dropping out might require more time for exposures than intended in the treatment manual.…”

Section: Introductionmentioning

confidence: 99%

“…The lack of strong and consistent findings in the literature may also result from therapist characteristics that influence the degree of adherence (Smith, Daunic, & Taylor, 2007;Webb et al, 2010) such as therapist competence and experience (Lambert & Bergin, 1994;Perepletchikova & Kazdin, 2005). Competence refers to the quality of treatment implementation and reflects the skills of the therapist such as the appropriate adaption of interventions and procedures, the style of communication and the ability for clinical reasoning (Perepletchikova & Kazdin, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…Competence refers to the quality of treatment implementation and reflects the skills of the therapist such as the appropriate adaption of interventions and procedures, the style of communication and the ability for clinical reasoning (Perepletchikova & Kazdin, 2005). A very low level of competence is assumed to not influence treatment outcome if a therapist is adherent enough to the protocol, whereas a medium to high level of competence might affect the relation between lower levels of adherence and outcome (Barber et al, 2006, CBT in 95 cocaine-dependent outpatients).…”

Section: Introductionmentioning

confidence: 99%

“…Contrary to common belief, therapists with more experience tend to have lower levels of adherence than less Therapist adherence to a treatment manual influences outcome and dropout rates International Journal of Research Studies in Psychology 5 experienced therapists (Henry et al, 1993;Siqueland et al, 2000). Some authors explained this by stating that experienced therapists stick to their established ways of conducting therapy (Margison et al, 2000) and have more barriers learning new therapeutic strategies (Perepletchikova & Kazdin, 2005). Considering the potential influence of competence and experience might help to identify the core mechanisms of adherence to a CBT manual in symptomatic outcome in patients with PD/AG.…”

Section: Introductionmentioning

confidence: 99%

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

Hauke¹,

Gloster²,

Gerlach³

et al. 2013

IJRSP

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Hauke¹,

Gloster²,

Gerlach³

et al. 2013

IJRSP

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Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety

et al. 2020

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Health anxiety is a common and often chronic mental health problem associated with distress, substantial costs, and frequent attendance throughout the health care system. Face-to-face cognitive behavior therapy (CBT) is the criterion standard treatment, but access is limited.OBJECTIVE To test the hypothesis that internet-delivered CBT, which requires relatively little resources, is noninferior to face-to-face CBT in the treatment of health anxiety. DESIGN, SETTING, AND PARTICIPANTSThis randomized noninferiority clinical trial with health economic analysis was based at a primary care clinic and included patients with a principal diagnosis of health anxiety who were self-referred or referred from routine care. Recruitment began in December 10, 2014, and the last treatment ended on July 23, 2017. Follow-up data were collected up to 12 months after treatment. Analysis began October 2017 and ended March 2020. INTERVENTIONS Patients were randomized (1:1) to 12 weeks of internet-delivered CBT or to individual face-to-face CBT.MAIN OUTCOMES AND MEASURES Change in health anxiety symptoms from baseline to week 12. Analyses were conducted from intention-to-treat and per-protocol (completers only) perspectives, using the noninferiority margin of 2.25 points on the Health Anxiety Inventory, which has a theoretical range of 0 to 54. RESULTS Overall, 204 patients (mean [SD] age, 39 [12] years; 143 women [70%]) contributed with 2386 data points on the Health Anxiety Inventory over the treatment period. Of 204 patients, 102 (50%) were randomized to internet-delivered CBT, and 102 (50%) were randomized to face-to-face CBT. The 1-sided 95% CI upper limits for the internet-delivered CBT vs face-to-face CBT difference in change were within the noninferiority margin in the intention-to-treat analysis (B = 0.00; upper limit: 1.98; Cohen d = 0.00; upper limit: 0.23) and per-protocol analysis (B = 0.01; upper limit: 2.17; Cohen d = 0.00; upper limit: 0.25). The between-group effect was not moderated by initial symptom level, recruitment path, or patient treatment preference. Therapists spent 10.0 minutes per patient per week in the online treatment vs 45.6 minutes for face-to-face CBT. The net societal cost was lower in the online treatment (treatment period point difference: $3854). There was no significant group difference in the number of adverse events, and no serious adverse event was reported.

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Offending Behaviour Programmes

Hollin¹,

Palmer²

2006

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Treatment integrity and therapeutic change: Issues and research recommendations.

Cited by 367 publications

References 97 publications

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

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

Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety

Offending Behaviour Programmes

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