Abstract
Therapist competence is an important factor in treatment integrity. This study reports on a direct comparison of the original Cognitive Therapy Scale (CTS) with the revised version, the Cognitive Therapy Scale-Revised (CTS-R), as observational instruments designed to evaluate therapist competence in a completed trial of Cognitive Behavior Therapy (CBT) for depression. Treatment sessions (N = 94) from 50 depressed participants (M age = 39.2 years, 76% female, with an average of 5.9 depressive episodes) were evaluated on the CTS and CTS-R by trained independent observers who were blind to treatment outcome, as well as to subject, and session numbers. A comprehensive training program and inter-rater reliability monitoring protocol were employed. Two models were used to compare CTS and CTS-R in relation to change in depression symptoms at termination, 12 and 24 month follow-up while controlling for pre-treatment depression levels and working alliance. Both the CTS and CTS-R demonstrated comparable internal reliability, interrater reliability, and when assessed in early treatment phase, both predicted a statistically significant reduction in depressive symptomatology at termination. No significant competence-outcome relations were detected with late CTS and CTS-R ratings, and the significant positive interaction terms indicated relations with depressive symptomatology were not maintained at follow-up. Given these findings, we encourage future research to examine specific competence domains and “therapist drift” with an increased number of session assessments.
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Notes
A non-normal data distribution was evident with present study WAI data, so the statistical assumptions for the ICC index were violated (Whitehurst, 1985) and the Finn’s r index was chosen to measure interrater reliability. Finn’s r is less affected by restricted range and non-normal data (Tinsley & Weiss, 2000) and has been adopted in prior clinical research (see Fenton et al., 2000; Raue et al. 1993).
If a specific session recording was unavailable or inaudible, the nearest contiguous session recording was used to rate the CTS and CTS-R within a maximum range of three sessions (e.g., if session 15 was unavailable, the next available recording was within the range of sessions 12–18). The early phase of therapy was represented by session 2 (n = 2), session 3 (n = 44), session 5 (n = 1), and session 6 (n = 1), totaling n = 48 sessions. The late phase of therapy was represented by session 12 (n = 3), and session 15 (n = 43), totaling n = 46 sessions.
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Kazantzis, N., Clayton, X., Cronin, T.J. et al. The Cognitive Therapy Scale and Cognitive Therapy Scale-Revised as Measures of Therapist Competence in Cognitive Behavior Therapy for Depression: Relations with Short and Long Term Outcome. Cogn Ther Res 42, 385–397 (2018). https://doi.org/10.1007/s10608-018-9919-4
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DOI: https://doi.org/10.1007/s10608-018-9919-4