Quality of cognitive-behavioural therapy in routine psychiatric care: therapist adherence and competence, and patient outcomes for depression and anxiety disorders.

IF 3.4 2区 医学 Q2 PSYCHIATRY
Hillevi Bergvall, Johanna Linde, Sven Alfonsson, Rikard Sunnhed, Jacques P Barber, Tobias Lundgren, Gerhard Andersson, Benjamin Bohman
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Abstract

Background: Quality of care is essential for the dissemination of evidence-based practices, yet therapist adherence and competence are seldom assessed. We examined the quality of delivery of cognitive-behavioural therapy (CBT) in routine psychiatric care for depression and anxiety disorders, considering therapist adherence and competence, and therapy effectiveness, as well as their associations.

Methods: Twenty-nine therapists recruited 85 patients with a principal diagnosis of depression or anxiety disorder from two routine psychiatric outpatient clinics in Stockholm, Sweden. Therapist adherence was assessed mid-CBT by observers and post-CBT by patients and therapists, respectively, using an instrument developed as part of the present study. Therapist competence was assessed using role-plays with a standardised patient. Patients rated symptoms, functional impairment, and global health pre- and post-CBT. Linear mixed models were used to analyse associations.

Results: Therapist adherence was high according to patients, moderate to high according to therapists, and moderate according to observers. Most therapists demonstrated competence in CBT, as assessed using the Cognitive Therapy Scale-Revised (M = 40.5, SD = 6.5; 76% passed the ≥ 36 points competence threshold). Patients improved significantly from pre- to post-CBT across outcome measures (Cohen's ds = 0.80 - 1.36). Neither therapist adherence nor competence was associated with patient outcomes.

Conclusions: In routine psychiatric care, therapists delivered CBT with adherence, competence, and improvements for patients with depression and anxiety disorders, on par with previous research results in controlled settings. The implications for quality assessment and improvement are discussed.

Trial registration: ClinicalTrials.gov NCT03625024 10/08/2018.

常规精神科护理中认知行为治疗的质量:治疗师的依从性和能力,以及抑郁症和焦虑症患者的预后。
背景:护理质量对循证实践的传播至关重要,但治疗师的依从性和能力很少得到评估。我们考察了认知行为疗法(CBT)在抑郁症和焦虑症常规精神护理中的质量,考虑到治疗师的依从性和能力、治疗效果以及它们之间的关联。方法:29名治疗师从瑞典斯德哥尔摩的两家常规精神科门诊诊所招募了85名主要诊断为抑郁症或焦虑症的患者。治疗师的依从性在cbt中期由观察者评估,cbt后由患者和治疗师分别评估,使用作为本研究一部分开发的工具。治疗师的能力通过与标准化患者的角色扮演来评估。患者对cbt前后的症状、功能损害和整体健康状况进行评分。线性混合模型用于分析相关性。结果:患者依从性高,治疗师依从性中至高,观察者依从性中。大多数治疗师在CBT方面表现出能力,使用认知治疗量表-修订版进行评估(M = 40.5, SD = 6.5;76%通过≥36分能力阈值)。通过结果测量,患者从cbt前到cbt后显著改善(Cohen’s ds = 0.80 - 1.36)。治疗师的依从性和能力都与患者的预后无关。结论:在常规精神科护理中,治疗师对抑郁症和焦虑症患者的CBT治疗具有依从性、能力和改善,与之前在对照环境中的研究结果相当。讨论了质量评价和改进的意义。试验注册:ClinicalTrials.gov nct0362502410/08/2018。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Psychiatry
BMC Psychiatry 医学-精神病学
CiteScore
5.90
自引率
4.50%
发文量
716
审稿时长
3-6 weeks
期刊介绍: BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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