Treatment Integrity in Psychotherapy Research: Analysis of the Studies and Examination of the Associated Factors

Department of Psychology, Yale University, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 01/2008; 75(6):829-41. DOI: 10.1037/0022-006X.75.6.829
Source: PubMed

ABSTRACT Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as predictors of their implementation. Randomized controlled trials of psychosocial interventions published in 6 influential psychological and psychiatric journals were reviewed and coded for treatment integrity implementation. Results indicate that investigations that systematically addressed treatment integrity procedures are virtually absent in the literature. Treatment integrity was adequately addressed for only 3.50% of the evaluated psychosocial interventions. Journal of publication and treatment approach predicted integrity implementation. Skill-building treatments (e.g., cognitive-behavioral) as compared with non-skill-building interventions (e.g., psychodynamic, nondirective counseling) were implemented with higher attention to integrity procedures. Guidelines for implementation of treatment integrity procedures need to be reevaluated.

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    • "Treatment fidelity is most often described as adherence, or how much the treatment procedures are followed as intended (Gresham et al. 1993; Perepletchikova et al. 2007). Other definitions of fidelity include competence, defined as staff skills related to implementation (Perepletchikova et al. 2007), and intensity or dosage, often measured as hours per week of treatment delivery (Peters-Scheffer et al. 2010). There is some disagreement on the best way to measure fidelity. "
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    ABSTRACT: This study evaluated the association of fidelity to each of the components of the Strategies for Teaching based on Autism Research (STAR) program, a comprehensive treatment package for children with autism that includes discrete trial training, pivotal response training, and teaching in functional routines, on outcomes for 191 students ages 5-8 years in a large public school district. Fidelity to all components was relatively low, despite considerable training and support, suggesting the need to develop new implementation strategies. Fidelity to pivotal response training, but not discrete trial training or functional routines, was positively associated with gains in cognitive ability despite low levels of fidelity, and may be an effective intervention choice in under-resourced settings.
    Journal of Autism and Developmental Disorders 04/2015; 45(9). DOI:10.1007/s10803-015-2455-0 · 3.06 Impact Factor
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    • "In a study of RCTs between 2000 and 2004, Perepletchikova, Treat, and Kazdin (2007) found that RCTs involving skills based treatments, such as cognitive behavioural therapy, measured adherence to manualised more than those involving process orientated therapies, such a psychodynamic therapy. The authors suggested that lack of practice taxonomy posed " threats to experiment validity and had serious implications for inferences drawn about the relationship between treatment and outcome " (Perepletchikova et al., 2007, p. 829). "
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    ABSTRACT: This paper outlines a study which sought to understand how art therapists structure their approach to treating those with borderline personality disorder features. It outlines the understanding of the condition, controversies around diagnosis and its use by evidence based psychological therapies as a guide for structuring therapy. The paper considers how art therapists might utilise research to improve art therapy for this distressing condition. The authors argue that before undertaking clinical trials, art therapists need to build theory inductively so that there is clarity about what is tested. They surveyed art therapists internationally to try to understand how whether there was consistency in how they structured their approach and received usable description of 226 interventions with over 140 names. The results indicate that most art therapists carefully prepare service users for treatment through sharing a clear understanding of the condition and treatment aims and pay particular attention to the attachment issues involved. The study concludes by suggesting any trial of art therapy with borderline personality disorder features should include these structures in the approach studied. The authors suggest that the existing taxonomy for art therapy does not describe the approach of practitioners take and recommend terminology should reflect structure and not therapist intentions.
    The Arts in Psychotherapy 03/2015; 43. DOI:10.1016/j.aip.2014.10.013 · 0.58 Impact Factor
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    • "However, trial evaluations rarely include an assessment of the extent to which interventions are delivered and received as planned (fidelity), to what extent they are adapted, and what this means for long-term implementation and impact in routine clinical practice [2,3]. A review of 202 psychosocial treatment evaluations showed that fidelity was only adequately addressed in 3.5% of the treatments [4]; and a review of 162 evaluations of primary and early secondary prevention programs showed that only 24.1% reported fidelity procedures [5]. Fidelity assessment is also rare for behaviour change interventions to support medication adherence. "
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    ABSTRACT: Implementation of trial interventions is rarely assessed, despite its effects on findings. We assessed the implementation of a nurse-led intervention to facilitate medication adherence in type 2 diabetes (SAMS) in a trial against standard care in general practice. The intervention increased adherence, but not through the hypothesised psychological mechanism. This study aimed to develop a reliable coding frame for tape-recorded consultations, assessing both a priori hypothesised and potential active ingredients observed during implementation, and to describe the delivery and receipt of intervention and standard care components to understand how the intervention might have worked. 211 patients were randomised to intervention or comparison groups and 194/211 consultations were tape-recorded. Practice nurses delivered standard care to all patients and motivational and action planning (implementation intention) techniques to intervention patients only. The coding frame was developed and piloted iteratively on selected tape recordings until a priori reliability thresholds were achieved. All tape-recorded consultations were coded and a random subsample double-coded. Nurse communication, nurse-patient relationship and patient responses were identified as potential active ingredients over and above the a priori hypothesised techniques. The coding frame proved reliable. Intervention and standard care were clearly differentiated. Nurse protocol adherence was good (M (SD) = 3.95 (0.91)) and competence of intervention delivery moderate (M (SD) = 3.15 (1.01)). Nurses frequently reinforced positive beliefs about taking medication (e.g., 65% for advantages) but rarely prompted problem solving of negative beliefs (e.g., 21% for barriers). Patients’ action plans were virtually identical to current routines. Nurses showed significantly less patient-centred communication with the intervention than comparison group. It is feasible to reliably assess the implementation of behaviour change interventions in clinical practice. The main study results could not be explained by poor delivery of motivational and action planning components, definition of new action plans, improved problem solving or patient-centred communication. Possible mechanisms of increased medication adherence include spending more time discussing it and mental rehearsal of successful performance of current routines, combined with action planning. Delivery of a new behaviour change intervention may lead to less patient-centred communication and possible reduction in overall trial effects. Trial registration ISRCTN30522359.
    Implementation Science 06/2014; 9(1):70. DOI:10.1186/1748-5908-9-70 · 4.12 Impact Factor
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