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Measuring fidelity of brief cognitive behavior therapy for insomnia: Development, reliability and validity
Wendi F Cross1, Janet McCarten2, Jennifer S Funderburk3
1University of Rochester Medical Center, USA; Center of Excellence for Suicide Prevention, USA.
Evaluation and Program Planning
|December 18, 2024
Summary
Therapist adherence to cognitive behavioral therapy for insomnia (CBT-I) significantly reduced depression symptoms in veterans. New fidelity measures reliably assessed therapist competence and adherence, impacting treatment outcomes.
Area of Science:
- Psychology
- Clinical Research
- Health Services Research
Background:
- Measuring implementation fidelity is crucial for program evaluation, linking how interventions are delivered to their outcomes.
- Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based treatment, with brief variants (bCBTi) showing efficacy for insomnia and depression.
- The influence of therapist fidelity on bCBTi outcomes remains unclear due to a lack of reliable measurement tools.
Purpose of the Study:
- To develop and validate measures of therapist fidelity for brief CBT-I (bCBTi).
- To assess the impact of therapist fidelity on treatment outcomes in a pilot study involving veterans.
Main Methods:
- Therapist adherence and competence were coded from audio recordings of 23 veterans receiving bCBTi.
- Inter-rater reliability and internal consistency were established for the fidelity measures.
- The association between fidelity measures and treatment outcomes (depression) was analyzed.
Main Results:
- Reliable measures for therapist adherence (ICC = .73-.80) and competence (ICC = .57, alpha = .75) were developed.
- Adherence and competence showed low shared variance (10%).
- Therapist adherence was significantly associated with decreased depression symptoms, supporting the predictive validity of the fidelity measures.
Conclusions:
- The developed fidelity measures are reliable and valid for assessing bCBTi delivery.
- Therapist adherence is a significant factor influencing depression outcomes in veterans receiving bCBTi.
- These findings highlight the importance of monitoring therapist fidelity in clinical practice and research.
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