Bergvall Hillevi, Linde Johanna, Alfonsson Sven, Sunnhed Rikard, Barber Jacques P, Lundgren Tobias, Andersson Gerhard, Bohman Benjamin
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA.
BMC Psychiatry. 2024 Dec 4;24(1):887. doi: 10.1186/s12888-024-06328-4.
Quality of care is essential for the dissemination of evidence-based practices, yet therapist adherence and competence are seldom assessed. We examined the quality of delivery of cognitive-behavioural therapy (CBT) in routine psychiatric care for depression and anxiety disorders, considering therapist adherence and competence, and therapy effectiveness, as well as their associations.
Twenty-nine therapists recruited 85 patients with a principal diagnosis of depression or anxiety disorder from two routine psychiatric outpatient clinics in Stockholm, Sweden. Therapist adherence was assessed mid-CBT by observers and post-CBT by patients and therapists, respectively, using an instrument developed as part of the present study. Therapist competence was assessed using role-plays with a standardised patient. Patients rated symptoms, functional impairment, and global health pre- and post-CBT. Linear mixed models were used to analyse associations.
Therapist adherence was high according to patients, moderate to high according to therapists, and moderate according to observers. Most therapists demonstrated competence in CBT, as assessed using the Cognitive Therapy Scale-Revised (M = 40.5, SD = 6.5; 76% passed the ≥ 36 points competence threshold). Patients improved significantly from pre- to post-CBT across outcome measures (Cohen's ds = 0.80 - 1.36). Neither therapist adherence nor competence was associated with patient outcomes.
In routine psychiatric care, therapists delivered CBT with adherence, competence, and improvements for patients with depression and anxiety disorders, on par with previous research results in controlled settings. The implications for quality assessment and improvement are discussed.
ClinicalTrials.gov NCT03625024 10/08/2018.
护理质量对于循证实践的传播至关重要，但很少评估治疗师的依从性和能力。我们考察了在抑郁症和焦虑症的常规精神科护理中认知行为疗法（CBT）的实施质量，同时考虑了治疗师的依从性、能力、治疗效果及其之间的关联。
29名治疗师从瑞典斯德哥尔摩的两家常规精神科门诊招募了85名主要诊断为抑郁症或焦虑症的患者。治疗师的依从性在CBT治疗中期由观察者评估，在CBT治疗后分别由患者和治疗师评估，使用作为本研究一部分开发的工具。治疗师的能力通过与标准化患者进行角色扮演来评估。患者在CBT治疗前后对症状、功能损害和整体健康状况进行评分。采用线性混合模型分析关联。
根据患者的评估，治疗师的依从性较高；根据治疗师的评估，依从性为中度至高度；根据观察者的评估，依从性为中度。使用修订后的认知治疗量表评估，大多数治疗师在CBT方面表现出能力（M = 40.5，标准差 = 6.5；76% 通过了≥36分的能力阈值）。从治疗前到治疗后，患者在各项结果指标上均有显著改善（科恩d值 = 0.80 - 1.36）。治疗师的依从性和能力均与患者的治疗结果无关。
在常规精神科护理中，治疗师对抑郁症和焦虑症患者实施了具有依从性、能力且能使患者改善的CBT，与之前在对照环境中的研究结果相当。讨论了对质量评估和改进的启示。
ClinicalTrials.gov NCT03625024 2018年8月10日。
