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2 results

  • Predicting therapist adherence to the CRA manual in addiction care

  • Anneleen E.M. Kraan, Wiebren Markus, Arnt F.A. Schellekens, Boukje A.G. Dijkstra
  • Journal:
    The Cognitive Behaviour Therapist / Volume 16 / 2023
    Published online by Cambridge University Press:
    12 October 2023, e28
    • Article
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  • Abstract

    Although manual-based treatments are widely available in mental health care, they are often not delivered according to protocol. Treatment-, therapist- and organizational-related determinants are known to affect therapist adherence to treatment protocols, and subsequently treatment success. This study examined which determinants are associated with therapist adherence to the Community Reinforcement Approach (CRA) manual, an evidence-based behavioural treatment programme commonly used in addiction care. Using a cross-sectional design, adherence to the CRA manual and potential contributing determinants were assessed through a self-report survey among therapists (N = 69) working in out-patient addiction care. Correlation analysis and backward stepwise regression analysis were used to examine which treatment-, therapist- and organizational-related determinants were associated with CRA adherence. Significant associations with self-reported CRA adherence were found for nine out of 16 determinants examined. Three independent determinants explained 43% of the variance in CRA manual adherence, namely compatibility with the working method therapists were used to, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues. These determinants should be considered when implementing CRA in addiction care, for example by investing in training and taking into account therapists’ previous treatment experience. This also accounts for creating positive outcome expectations and the use of descriptive norms by making experiences explicit of therapists and teams that excel. Future research should investigate which other determinants contribute to therapists’ adherence and focus on clarifying causality between determinants and adherence.

    Key learning aims

    1. (1) To understand the importance of treatment, therapist and organizational determinants influencing therapist adherence to the CRA manual.

    2. (2) To explain the three determinants that make the largest contribution to self-reported therapists’ adherence to the CRA manual, namely: compatibility with the working method, perceived outcome expectations, and perceived adoption of CRA procedures by colleagues.

    3. (3) To reflect on the clinical implications regarding therapist training, implementation of manual-based treatments and future research.

  • ASSESSING THERAPIST ADHERENCE TO COGNITIVE-BEHAVIOUR THERAPY FOR PSYCHOSIS

  • Mike Startup, Mike Jackson, Emma Pearce
  • Journal:
    Behavioural and Cognitive Psychotherapy / Volume 30 / Issue 3 / July 2002
    Published online by Cambridge University Press:
    26 July 2002, pp. 329-339
    Print publication:
    July 2002

  • Recently, several RCTs have provided preliminary evidence that cognitive-behavioural therapy (CBT) is effective in the treatment of people suffering from schizophrenia. However, none of these trials has provided complete demonstrations of therapist adherence. Since no suitable scale existed already, the authors devised the Cognitive Therapy for Psychosis Adherence Scale (CTPAS). The main aim of the present research was to test whether the 12 items of this scale could be rated reliably. Ratings were made on 29 sessions of CBT for schizophrenia by two raters independently and their agreement was found to be at least adequate on 10 of the items of the CTPAS. Ratings were also made on relevant items of the Collaborative Study Psychotherapy Rating Scale and agreement was found to be more than adequate for three factor-based subscales derived from these items. The results suggest therapist adherence to CBT for psychosis can be rated reliably and that the CTPAS is likely to be useful in future research on this form of treatment.