Department of Psychology, Ohio State University, Columbus, OH 43210, USA.
J Consult Clin Psychol. 2010 Jun;78(3):429-37. doi: 10.1037/a0019631.
The efficacy of cognitive therapy (CT) for depression has been well established. Measures of the adequacy of therapists' delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have shown an association between CT competence and outcome, researchers have yet to address whether competence ratings predict subsequent outcomes.
In a sample of 60 moderately to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change.
Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on prediction of symptom change following 4 early sessions through the end of 16 weeks of treatment, competence was shown to be a significant predictor of evaluator-rated end-of-treatment depressive symptom severity and was predictive of self-reported symptom severity at the level of a nonsignificant trend. To investigate whether competence is more important to clients with specific complicating features, we examined 4 patient characteristics as potential moderators of the competence-outcome relation. Competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia) than for those patients without these characteristics. Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. those who did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial).
These findings provide support for the potential utility of CT competence ratings in applied settings.
认知疗法（CT）治疗抑郁症的疗效已得到充分证实。评估治疗师提供治疗的充分性的措施对于促进治疗师培训和治疗传播至关重要。虽然一些研究表明 CT 能力与结果之间存在关联，但研究人员尚未解决能力评分是否预测后续结果的问题。
在一项临床试验中，我们对 60 名中度至重度抑郁的门诊患者进行了样本研究，使用认知治疗量表（Cognitive Therapy Scale）评估了治疗师的能力评分，以预测随后的症状变化。
能力评分可预测治疗早期的治疗过程中症状的变化。在分析专注于通过治疗的前 4 次随访预测治疗的前 16 周结束时的症状变化时，能力评分被证明是评估者评定的治疗结束时抑郁症状严重程度的显著预测因子，并且在非显著趋势水平上预测了自我报告的症状严重程度。为了研究能力是否对具有特定并发症特征的患者更为重要，我们研究了 4 种患者特征作为能力-结果关系的潜在调节因素。与没有这些特征的患者相比，具有较高焦虑、发病年龄较早和（在趋势水平上）具有慢性抑郁（慢性抑郁症或心境恶劣）的患者，其能力评分与随后的结果相关性更高。对于符合（与不符合）人格障碍标准的患者（即临床试验中代表的人格障碍），能力评分对后续结果的预测性不高。
这些发现为在应用环境中使用 CT 能力评分提供了支持。
