Weck Florian, Grikscheit Florian, Höfling Volkmar, Stangier Ulrich
University of Frankfurt.
University of Frankfurt.
Behav Ther. 2014 Jul;45(4):541-52. doi: 10.1016/j.beth.2014.03.003. Epub 2014 Mar 14.
The evaluation of treatment integrity (therapist adherence and competence) is a necessary condition to ensure the internal and external validity of psychotherapy research. However, the evaluation process is associated with high costs, because therapy sessions must be rated by experienced clinicians. It is debatable whether rating session segments is an adequate alternative to rating entire sessions. Four judges evaluated treatment integrity (i.e., therapist adherence and competence) in 84 randomly selected videotapes of cognitive-behavioral therapy for major depressive disorder, social anxiety disorder, and hypochondriasis (from three different treatment outcome studies). In each case, two judges provided ratings based on entire therapy sessions and two on session segments only (i.e., the middle third of the entire sessions). Interrater reliability of adherence and competence evaluations proved satisfactory for ratings based on segments and the level of reliability did not differ from ratings based on entire sessions. Ratings of treatment integrity that were based on entire sessions and session segments were strongly correlated (r=.62 for adherence and r=.73 for competence). The relationship between treatment integrity and outcome was comparable for ratings based on session segments and those based on entire sessions. However, significant relationships between therapist competence and therapy outcome were only found in the treatment of social anxiety disorder. Ratings based on segments proved to be adequate for the evaluation of treatment integrity. The findings demonstrate that session segments are an adequate and cost-effective alternative to entire sessions for the evaluation of therapist adherence and competence.
治疗完整性（治疗师的依从性和胜任力）评估是确保心理治疗研究的内部和外部效度的必要条件。然而，评估过程成本高昂，因为治疗环节必须由经验丰富的临床医生进行评分。对治疗环节进行评分是否足以替代对整个治疗过程进行评分，这一点存在争议。四位评判员对84份随机抽取的针对重度抑郁症、社交焦虑症和疑病症的认知行为治疗录像带（来自三项不同的治疗结果研究）的治疗完整性（即治疗师的依从性和胜任力）进行了评估。在每种情况下，两位评判员基于整个治疗环节进行评分，另外两位仅基于治疗环节片段（即整个环节的中间三分之一）进行评分。结果表明，基于片段的依从性和胜任力评估的评判员间信度令人满意，且信度水平与基于整个治疗环节的评分没有差异。基于整个治疗环节和治疗环节片段的治疗完整性评分高度相关（依从性r = 0.62，胜任力r = 0.73）。基于治疗环节片段和基于整个治疗环节的评分，治疗完整性与治疗结果之间的关系具有可比性。然而，仅在社交焦虑症的治疗中发现了治疗师胜任力与治疗结果之间的显著关系。基于片段的评分被证明足以用于评估治疗完整性。研究结果表明，对于评估治疗师的依从性和胜任力而言，治疗环节片段是一种足够且具有成本效益的替代整个治疗环节的方法。
