Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

Abstract

Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy–Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.

Implementing evidence‐based treatment protocols: Flexibility within fidelity.

“…Efforts to train therapists in evidence-based protocols have been successful. For example, Smith et al (2017) examined how therapists in practice and research settings delivered the Coping Cat intervention for anxiety disorders. Providers were trained via a workshop led by an expert and subsequent ongoing supervision.…”

Effectiveness and Efficiency of Observationally Assessing Fidelity to a Family-Centered Child Intervention: A Quasi-Experimental Study

“…The empirical literature concerning the quality of EBP delivery in the community is sparse (Hoagwood & Kolko, 2009;Weisz, Jensen-Doss, & Hawley, 2006). When delivery of an EBP was evaluated in both research and community settings, there was a high degree of similarity but a lower dose of EBP elements and levels were more likely to wane over time in the community (M. Smith et al, 2017). Relatedly, adherence and competence ratings were lower for community therapists compared to therapists in research settings even with the same training and supervision protocols for both groups (McLeod et al, 2017).…”

“…It is challenging to compare the findings of this study to the existing literature because most studies examine ratings of fidelity within only one training condition-typically either the intervention group in an efficacy or effectiveness trial or a cohort of interventionists trained to deliver an EBP in a community setting. There are a few examples of fidelity evaluations in both effectiveness trials (e.g., McLeod et al, 2017;Smith et al, 2017;Southam-Gerow et al, 2010) and community practice. Some studies of community practice have examined only whether an EBP was used, but not to what extent it was delivered with fidelity (Santa Ana et al, 2008;Weisz et al, 2013), while others have sought to characterize the extent to which elements of EBPs exist in usual care, which has required a more detailed assessment of fidelity (e.g., Brookman-Frazee et al, 2010;Garland et al, 2010;Smith et al, 2017).…”

“…There are a few examples of fidelity evaluations in both effectiveness trials (e.g., McLeod et al, 2017;Smith et al, 2017;Southam-Gerow et al, 2010) and community practice. Some studies of community practice have examined only whether an EBP was used, but not to what extent it was delivered with fidelity (Santa Ana et al, 2008;Weisz et al, 2013), while others have sought to characterize the extent to which elements of EBPs exist in usual care, which has required a more detailed assessment of fidelity (e.g., Brookman-Frazee et al, 2010;Garland et al, 2010;Smith et al, 2017). There is a need for research on fidelity to EPBs when they are intentionally translated to real-worlds settings and how these protocols relate to services as usual (i.e., are they demonstrably and meaningfully different).…”

Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents

“… 7 , 8 However, other psychotherapies are also in use, such as BT without the cognitive restructuring component and bibliotherapy. 9 , 10 Nevertheless, debate regarding the different components and format of psychotherapy is ongoing, 11 for instance, whether cognitive maturity is required for successful engagement in CBT for young children and whether differences exist in efficacy between psychotherapy delivered individually or in a group setting. 12 These issues lead to uncertainty in the decision making for health care professionals and patients.…”