TY - JOUR
T1 - A pragmatic approach to measuring adherence in treatment delivery in psychotherapy
AU - Serfaty, Marc
AU - Shafran, Roz
AU - Vickerstaff, Victoria
AU - Aspden, Trefor
N1 - Funding Information:
Supported by the UCLH NIHR BRC.
Funding Information:
This research was supported by National Institute of Health Research - Health Technology Assessment [grant number NIHR-HTA ?09/33/02]. Supported by the UCLH NIHR BRC. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We wish to thank the participants for supporting this study and therapists for taking part in the study and completing the TCC. We also wish to thank Dr S Singh for his independent ratings of therapy, Dr S Moorey and K Mannix for their preparation of the CanTalk treatment manual and help with developing the TCC and Dr A Gola for the Health Economics advice. We also wish to thank Professor D Veale for his helpful comments.
Publisher Copyright:
© 2020 Swedish Association for Behaviour Therapy.
PY - 2020/9/2
Y1 - 2020/9/2
N2 - Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.
AB - Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.
KW - Therapy
KW - cognitive behaviour therapy
KW - adherence
KW - reliability
KW - cognitive therapy
KW - Reproducibility of Results
KW - Humans
KW - Self Report
KW - Cognitive Behavioral Therapy/economics
KW - Treatment Outcome
KW - Checklist/statistics & numerical data
KW - Clinical Competence/statistics & numerical data
KW - Depression/complications
KW - Cost-Benefit Analysis/statistics & numerical data
KW - Neoplasms/complications
UR - http://www.scopus.com/inward/record.url?scp=85080916510&partnerID=8YFLogxK
U2 - 10.1080/16506073.2020.1717594
DO - 10.1080/16506073.2020.1717594
M3 - Article
C2 - 32114905
SN - 1651-2316
VL - 49
SP - 347
EP - 360
JO - Cognitive Behaviour Therapy
JF - Cognitive Behaviour Therapy
IS - 5
ER -
