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Assessing treatment integrity in cognitive-behavioral therapy: comparing session segments with entire sessions
Florian Weck1, Florian Grikscheit1, Volkmar Höfling1
1University of Frankfurt.
Behavior Therapy
|June 11, 2014
Summary
Evaluating therapist adherence and competence in psychotherapy research can be done using session segments, offering a cost-effective alternative to rating entire sessions. This method maintains reliability and validity in treatment integrity assessments.
Area of Science:
- Psychology
- Clinical Psychology
- Psychotherapy Research
Background:
- Treatment integrity, including therapist adherence and competence, is crucial for psychotherapy research validity.
- Evaluating treatment integrity typically requires costly ratings of entire therapy sessions by experienced clinicians.
- The efficacy of using shorter session segments as an alternative to full session ratings remains debated.
Purpose of the Study:
- To determine if rating session segments is an adequate and cost-effective substitute for rating entire therapy sessions in evaluating treatment integrity.
- To compare the interrater reliability and correlation of treatment integrity ratings (adherence and competence) between entire sessions and session segments.
- To assess if the relationship between treatment integrity and therapy outcome differs when using session segments versus entire sessions.
Main Methods:
- Four judges evaluated treatment integrity (adherence and competence) on 84 videotaped cognitive-behavioral therapy sessions for major depressive disorder, social anxiety disorder, and hypochondriasis.
- Two judges rated entire sessions, while two judges rated only the middle third segment of each session.
- Interrater reliability and correlations between segment and full session ratings were calculated.
Main Results:
- Satisfactory interrater reliability for adherence and competence was achieved using session segments, comparable to full session ratings.
- Ratings of treatment integrity based on segments and entire sessions were strongly correlated (r=.62 for adherence, r=.73 for competence).
- The relationship between treatment integrity and therapy outcome was similar whether using segments or entire sessions, though therapist competence was significantly linked to outcome only in social anxiety disorder treatment.
Conclusions:
- Session segments are an adequate and cost-effective alternative to entire sessions for evaluating therapist adherence and competence in psychotherapy research.
- Utilizing session segments can reduce the costs associated with treatment integrity evaluations without compromising research validity.
- These findings support the use of session segments for reliable and valid assessment of treatment integrity in clinical trials.
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