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


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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    • "829). A study investigating psychosocial interventions published in six prominent psychological and psychiatric journals found that treatment integrity was adequately assessed for only 3.5% of the interventions (Perepletchikova et al., 2007). This may imply that the vast majority of treatment studies published to date do not include measures of whether the treatments in research trials are conducted as intended. "
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    ABSTRACT: The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p < .001. Novice raters (graduate psychology students) obtained satisfactory accuracy (ICC > .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats. (PsycINFO Database Record
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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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    • "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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