A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

Cognitive Behavioural Therapy (CBT) is an effective evidence-based treatment for depression and anxiety. CBT involves a number of separate components aimed at changing unhelpful behaviour patterns and challenging unhelpful thinking styles. Recording which of these components are used in therapy sessions can be useful in both clinical practice and research contexts. In clinical practice, it can help the therapist reflect on their own practice and recall which techniques they have used in previous sessions. In research, a treatment manual is often used to ensure standardised delivery, and it can be useful to know how closely the delivered therapy conformed to this manual.

A common method of measuring adherence to a treatment manual is through observer ratings of recorded therapy sessions. However, these can be costly and time consuming, as well as being subject to rater-bias. We developed an alternative approach to measuring the components of therapy used in each session, and developed a self-completed Therapy Component Checklist, which we piloted in a trial using manualised CBT to treat depression in people with advanced cancer. The Therapy Component Checklist is completed at the end of a therapy session by the therapist, to record the components of CBT that they used in the therapy session.

The results of this study suggest that self-completed Therapy Component Checklists are both quick and easy to complete, and agree closely with observer ratings of the components of therapy delivered. They therefore provide a quick, cost-effective and reliable way to measure the components of CBT used in a therapy session. In terms of time savings, the Therapy Component Checklist takes just 5 minutes to self-complete compared to the approximately 60 to 120 minutes that it can take to listen to and rate a recorded therapy session. In terms of costs, we estimate cost savings of the Therapy Component Checklist to be approximately £96 per therapy session compared to observer ratings of recorded therapy sessions.

The Therapy Component checklist has the potential to be used in routine clinical practice to help prevent “therapist drift”. For researchers, it offers a quick, cost effective and reliable way of measuring adherence to manualised therapy.

Read the full paper: Marc Serfaty, Roz Shafran, Victoria Vickerstaff & Trefor Aspden (in press). A pragmatic approach to measuring adherence in treatment delivery in psychotherapy, Cognitive Behaviour Therapy, DOI: 10.1080/16506073.2020.1717594

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