RESUMO
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.
Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Cooperação do Paciente/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Adulto , Idoso , Terapia Cognitivo-Comportamental , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Psychoeducation has proved to be an effective treatment method for the prevention of relapse in recurrent depression. However, little is known about the processes which could account for the effects of psychoeducational treatment. In this study, patients with recurrent depression (currently remitted) received, over a period of 8 months, 16 sessions of psychoeducational treatment, in order to prevent relapse. Therapist adherence and competence, and the therapeutic alliance, were investigated as predictors of reducing the recurrence risk in depression. Videotapes of 43 participants in a psychoeducational treatment for depression were analyzed, in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by means of a questionnaire. One year after treatment, no associations were found between therapist adherence or competence and the risk of relapse. The patients' view of the therapeutic alliance was moderately associated with the time to relapse. However, the correlation disappeared when controlled for the number of previous depressive episodes. The latter was the most important predictor of time to relapse, explaining 15% of variance.
Assuntos
Competência Clínica , Depressão/psicologia , Depressão/reabilitação , Cooperação do Paciente , Psicoterapia/métodos , Adulto , Idoso , Análise de Variância , Depressão/prevenção & controle , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Resultado do TratamentoRESUMO
For the evaluation of therapist competence in psychotherapeutic treatment, only highly experienced judges (experts) were found to be adequate, whereas therapist adherence could be assessed by nonexperts. Using experts implies high costs for the rating process. Therefore, an interesting question is whether experts are also necessary for the assessment of therapist adherence and competence in psychoeducational treatment. To test this, four judges evaluated therapist adherence and competence in 30 randomly selected videotaped sessions of manualized psychoeducation for recurrent depression. Two judges exhibited high clinical experience (experts) while two judges did not (novices). We could demonstrate that the novices were also able to evaluate therapists' adherence and competence in psychoeducative treatment with high reliability. Moreover, expert judgments were not more reliable than novice judgments. Adherence and competence ratings of experts and novices showed high concordance. These results carry implications in terms of reducing costs associated with the judgment process.