AI Article Synopsis
- The study emphasizes the importance of measuring therapist fidelity in cognitive behavioral therapy for insomnia (CBT-I), focusing on both adherence to treatment and the competence of delivery.
- Researchers developed reliable measures of therapist fidelity specifically for brief CBT-I and conducted a pilot study with veterans to evaluate their impact.
- Results indicated that higher therapist adherence was significantly linked to reduced depression, highlighting the influence of fidelity on treatment outcomes.
Article Abstract
Purpose: Measuring fidelity is critical in program evaluations to assess how implementation influences outcomes. Implementer fidelity is comprised of adherence to the treatment content and competence of treatment delivery. Cognitive behavioral therapy for insomnia (CBT-I) is well-established and empirically supported with variants such as brief CBTi (bCBTi) showing promise in reducing both insomnia and depression. The impact of therapist fidelity on treatment outcomes is unknown in part because reliable measures have not been available. We developed measures of therapist fidelity for bCBT-i and assessed the impact of fidelity in the context of a pilot study with veterans in primary care.
Methods/results: Audio recordings from 23 participants (78 % male) were coded. Therapist adherence measures were created for each session along with a single measure of therapist competence. Inter-rater reliability was established and predictive validity was determined. For total adherence, inter-rater reliability was excellent across sessions (ICC =.73 -.80). The competence measure showed good reliability across all sessions (ICC =.57) and was internally consistent (Cronbach's alpha =.75). There was only 10 % of shared variance between adherence and competence. All of the fidelity measures demonstrated associations with outcomes in the predicted direction; therapist adherence was significantly associated with decreased depression.
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| http://dx.doi.org/10.1016/j.evalprogplan.2024.102531 | DOI Listing |
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