Therapist adherence to cognitive-behavioural therapy and quality of care from a patient perspective

Despite efforts to implement evidence-based guidelines, little is known about the quality of cognitive-behavioural therapy (CBT) for depression, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder in routine clinical practice. The present study aimed to investigate therapist adherence to CBT, and related aspects of quality of care, from a patient perspective. In a cross-sectional study, 90 participants from 21 routine psychiatric outpatient units in Stockholm completed a web-based survey post-CBT. Participants reported a high degree of therapist adherence to CBT techniques and procedures (M = 3.02 on a scale of 0 to 4), with higher adherence for social anxiety disorder and posttraumatic stress disorder than for depression (p = .002, ω² = 0.21). Therapist adherence was moderately correlated with patient improvement (τs = .37-.38, ps < .001). Participants reported a high degree of symptom improvement (M  = 3.10) and treatment satisfaction (M = 3.38) and received a median of 15 sessions. Also, we found examples of excessive healthcare provision and non-adherence, as 17% far exceeded the recommended number of sessions, 80% had concurrent psychotropic treatments despite lower guideline priority, and 11% took benzodiazepines though not recommended. In conclusion, we found that CBT was delivered with high quality.