Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors.

Abstract

Treatment integrity refers to the degree to which an intervention is delivered as intended. Two studies evaluated the adequacy of treatment integrity procedures (including establishing, assessing, evaluating, and reporting integrity; therapist treatment adherence; and therapist competence) implemented in psychotherapy research, as well as predictors of their implementation. Randomized controlled trials of psychosocial interventions published in 6 influential psychological and psychiatric journals were reviewed and coded for treatment integrity implementation. Results indicate that investigations that systematically addressed treatment integrity procedures are virtually absent in the literature. Treatment integrity was adequately addressed for only 3.50% of the evaluated psychosocial interventions. Journal of publication and treatment approach predicted integrity implementation. Skill-building treatments (e.g., cognitive-behavioral) as compared with non-skill-building interventions (e.g., psychodynamic, nondirective counseling) were implemented with higher attention to integrity procedures. Guidelines for implementation of treatment integrity procedures need to be reevaluated.

The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs

“…Fidelity can play a critical role in both clinical research and the dissemination of evidence-based practices. Fidelity is a multifaceted construct which is composed of the interrelated subdomains of adherence (inclusion of prescribed elements), differentiation (whether treatments differ along critical dimensions), and provider competence (Perepletchikova, Treat, & Kazdin, 2007).…”

“…Competence, defined as "the level of the [provider's] skill and judgment" in administering a manualized treatment (Perepletchikova et al, 2007;p. 829), is an important focus of implementation research for several reasons.…”

The Development of a MBCT Self-Assessment Scale

“…The benefits of in building adherence and competence domains is explained by Waltz [47] and Perepletchikova [28] who argued that despite the importance of contextual variables in treatment, many research studies have failed to emphasise the significance of measuring adherence and competence of clinicians' performances, which in turn influences treatment implementations and outcomes. It was envisioned the inclusion of a third domain concentrating on confidence would best support self regulation and mastery in learning; such an approach is in line with clinicians' identifying their weaknesses and strengths to realise learning goals [48] and "Self Regulations Learning" Theory [49].…”

“…The degree to which an intervention or program is delivered with high treatment fidelity in a clinical trial [25][26][27][28][29] maximises opportunity to replicate the study [30] improves confidence that any positive changes detected are directly attributable to the intervention, increases statistical power and reduces unintended variability [31,32]. On the other hand inadequate treatment fidelity can lead to the rejection of potentially powerful treatments or conversely to the acceptance of ineffective programs [31,32].…”

A Prenatal Coparenting Intervention With Unmarried Father–Mother Dyads: Fidelity of Intervention Delivery by Male–Female Community Mentor Teams

“…Two dimensions of method fidelity have been central in studies of implementation fidelity: adherence to core program criteria as specified in manuals and competent delivery of the program (Dumas, Lynch, Laughlin, Phillips Smith, & Prinz, 2001;Hogue, Liddle, Singer, & Leckrone, 2005;Perepletchikova, Treat, & Kazdin, 2007). Although adherence (delivering intervention components) is now most commonly assessed using a self-report instrument that is completed by the practitioner, ratings provided by trained nonparticipant observers provide a different and more objective assessment of adherence.…”