Development and evaluation of a scale assessing therapist fidelity to guidelines for delivering therapist-assisted Internet-delivered cognitive behaviour therapy. Issue 6 (2nd November 2018)

• Record Type: Journal Article
• Authors: Hadjistavropoulos, Heather D.; Schneider, Luke H.; Klassen, Kristen; Dear, Blake F.; Titov, Nickolai
• Is Part Of: Cognitive behaviour therapy. Volume 47:Issue 6(2018)
• Page Start: 447
• Page End: 461
• Publication Date: 2018-11-02
• Subjects: Therapist fidelity -- Internet-delivered cognitive behaviour therapy -- therapist-assistance -- depression -- anxiety; Cognitive therapy -- Periodicals; Behavior therapy -- Periodicals; 616.89142
• DOI: 10.1080/16506073.2018.1457079
• Languages: English
• ISSNs: 1650-6073

Abstract

Abstract: Internet-delivered cognitive behaviour therapy (ICBT) is often accompanied by therapist emails, but there is limited research on the quality of this therapist-assistance. In this study, an ICBT Therapist Rating Scale (ICBT-TRS) was developed and evaluated to assess whether therapist emails showed fidelity to specific therapist behaviours. Using data from a previous ICBT trial for depression and anxiety, the ICBT-TRS was used to rate 706 emails sent by 39 therapists to 91 randomly selected patients. Emails were rated for adherence (absent/present) and quality (inadequate/competent) on the following behaviours: Builds Rapport, Seeks Feedback, Provides Symptom Feedback, Provides Psychoeducation, Facilitates Understanding, Praises Effort, Encourages Practice, Clarifies Administrative Procedures, and Communicates Effectively . Inter-rater reliability was high. Most behaviours were identified as present in 72–100% of emails, with the exception of Provides Symptom Feedback and Facilitating Understanding which were only present in 54 and 61% of emails. The majority of emails were rated as high quality (88–98% of messages). While not related to symptom improvement, ICBT-TRS ratings were higher when patients were more engaged in ICBT (e.g. log-ins) and among therapists who specialized in ICBT or had a background in Psychology. The ICBT-TRS has potential to facilitate ICBT research and clinical training.