Evaluation of Treatment Integrity: The Treatment Specificity Index.

OBJECTIVE: To differentiate between treatments in a randomized controlled trial (RCT), therapies need to display not only high purity but also high specificity. The aim of this study was to demonstrate the benefits of calculating a treatment specificity index for the evaluation of treatment differentiation. METHOD: Based on an RCT of relapse prevention in depression, comparing a cognitive with a psychoeducational treatment, the specificity and the purity index were calculated. RESULTS: As indicated by the specificity index, both conditions differed in their levels of implemented specific and common interventions. A significant relationship was found between symptom change before a therapy session and treatment specificity. CONCLUSIONS: The specificity index is an appropriate method for enhancing the internal validity of RCTs in evaluating treatment integrity.

Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: the role of therapist adherence, competence, and the therapeutic alliance.

The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (≥ 5 vs. ≤ 4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance.

Reliability of adherence and competence assessment in cognitive behavioral therapy: influence of clinical experience.

The use of highly experienced expert judges was suggested for the assessment of therapists' adherence and competence. However, such an approach implies high costs. It can be questioned whether only experts are able to evaluate therapists' adherence and competence reliably. To test this, 4 judges evaluated therapist adherence and competence in 30 randomly selected videotapes of cognitive therapy sessions for depression. In that, 2 judges exhibited high clinical experience (experts), whereas 2 judges did not (novices). We could demonstrate that novices evaluated an aggregated adherence and competence measure with high reliability. However, several adherence and competence aspects were not assessed with satisfactory reliability by novices. Although adherence ratings of experts and novices showed high concordance, the concordance of competence ratings was only moderate. Results revealed that therapists' adherence could be evaluated satisfactorily by trained novices with some restrictions, but not their competence.

Prolonged grief disorder, depression, and posttraumatic stress disorder among bereaved Kosovar civilian war survivors: a preliminary investigation.

BACKGROUND: This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence. METHOD: We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events. RESULTS: The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD. CONCLUSION: The findings suggest that many cases of PGD would be missed by an exclusive focus on PTSD among bereaved war survivors.