Abstract
Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists' interpersonal behaviours and patients' active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness-based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater's explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory-II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients' active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists' interpersonal skills, and patients' active engagement did not predict posttreatment depressive symptom reduction. Patients' active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient's in-session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.
| Original language | English |
|---|---|
| Pages (from-to) | 84-93 |
| Number of pages | 10 |
| Journal | Clinical Psychology and Psychotherapy |
| Volume | 26 |
| Issue number | 1 |
| Early online date | 10 Sep 2018 |
| DOIs | |
| Publication status | Published - 30 Jan 2019 |
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Keywords
- UT-Hybrid-D
- interpersonal skills
- patient involvement
- randomized controlled trial
- treatment integrity
- depression
Cite this
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Explaining variability in therapist adherence and patient depressive symptom improvement : The role of therapist interpersonal skills and patient engagement. / Snippe, Evelien (Corresponding Author); Schroevers, Maya J.; Tovote, K. Annika; Sanderman, Robbert; Emmelkamp, Paul M.G.; Fleer, Joke.
In: Clinical Psychology and Psychotherapy, Vol. 26, No. 1, 30.01.2019, p. 84-93.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Explaining variability in therapist adherence and patient depressive symptom improvement
T2 - The role of therapist interpersonal skills and patient engagement
AU - Snippe, Evelien
AU - Schroevers, Maya J.
AU - Tovote, K. Annika
AU - Sanderman, Robbert
AU - Emmelkamp, Paul M.G.
AU - Fleer, Joke
N1 - Wiley deal
PY - 2019/1/30
Y1 - 2019/1/30
N2 - Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists' interpersonal behaviours and patients' active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness-based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater's explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory-II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients' active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists' interpersonal skills, and patients' active engagement did not predict posttreatment depressive symptom reduction. Patients' active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient's in-session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.
AB - Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists' interpersonal behaviours and patients' active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness-based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater's explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory-II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients' active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists' interpersonal skills, and patients' active engagement did not predict posttreatment depressive symptom reduction. Patients' active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient's in-session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.
KW - UT-Hybrid-D
KW - interpersonal skills
KW - patient involvement
KW - randomized controlled trial
KW - treatment integrity
KW - depression
UR - http://www.scopus.com/inward/record.url?scp=85053878070&partnerID=8YFLogxK
U2 - 10.1002/cpp.2332
DO - 10.1002/cpp.2332
M3 - Article
VL - 26
SP - 84
EP - 93
JO - Clinical psychology & psychotherapy
JF - Clinical psychology & psychotherapy
SN - 1063-3995
IS - 1
ER -