Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive–Behavioural Therapy for Panic Disorder

Clinical Psychology and Psychotherapy - Tập 23 Số 3 - Trang 272-284 - 2016
Hana F. Zickgraf1, Dianne L. Chambless1, Kevin S. McCarthy2,3, Robert Gallop4, Brian A. Sharpless2,5, Barbara Milrod6, Jacques P. Barber2,7
1Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
2Center for Psychotherapy Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
3Department of Psychology, Chestnut Hill College, Philadelphia, PA, USA
4Department of Mathematics, West Chester University, West Chester, PA, USA
5Department of Psychology, Washington State University, Pullman, WA USA
6Department of Psychiatry, Weill Medical College, Cornell University, New York, NY, USA
7Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY, USA

Tóm tắt

ObjectiveThe contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive–behavioural treatment (CBT) manual were tested.MethodThirty‐eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24‐session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV and the structured clinical interview for DSM‐IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory—short form.ResultsThe higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence.ConclusionsInterpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd.Key Practitioner message Patients' behavioural resistance to therapy may make it more difficult for cognitive–behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity.

Từ khóa


Tài liệu tham khảo

10.1037/0022-006X.74.2.377

10.1093/clipsy/9.4.421

10.1080/10503307.2011.610832

10.1001/jama.283.19.2529

10.1037/a0031437

Brown T. A., 2004, Anxiety disorders interview schedule adult version (ADIS‐IV): Client interview schedule

10.1037//0021-843X.110.1.49

10.1037/1040-3590.15.2.193

10.1093/clipsy/9.4.396

10.1037/0022-006X.64.3.497

Chamberlain P. Davis J. P. Forgatch M. Frey J. Patterson G. R. Ray J. …Trombley J.(1986).The therapy process code: A multidimensional system for observing therapist and client interactions. Unpublished manual Oregon Social Learning Center Eugene OR.

Chambless D. L. &Sharpless B. A.(2011).Adherence ratings for the panic control therapy protocol for psychotherapies for panic disorder study. Unpublished measure Department of Psychology University of Pennsylvania.

Cohen J., 1988, Statistical power analysis for the behavioral sciences

Craske M. G., 2000, Mastery of your anxiety and panic: Therapist guide for anxiety, panic, and agoraphobia

10.1080/10503309112331335511

10.1007/BF01172968

First M. B., 1997, Structured clinical interview for DSM‐IV Axis II personality disorders (SCID‐II)

10.1016/0165-0327(87)90029-2

10.1001/archpsyc.1991.01810360017002

Horvath A. O., 1986, The psychotherapeutic process: A research handbook, 529

10.1016/j.cbpra.2005.10.001

10.1016/j.drugalcdep.2010.11.010

10.1080/10503300802524343

Milrod B. Chambless D. L. Gallop R. McCarthy K. S. Sharpless B. A. &Barber J. P.(2014).Dynamic therapy vs. CBT vs. ART for panic disorder: A randomized controlled trial. Manuscript in preparation.

10.1176/ajp.2007.164.2.265

10.1001/jama.292.16.1969

10.1111/j.1468-2850.2011.01246.x

10.1093/clipsy/bpi045

10.1016/0005-7967(86)90143-9

Shoham V.(2011 September).Treatment fidelity: The elusive independent variable in psychotherapy research. Paper presented at the meeting of the North American Chapter of the Society for Psychotherapy Research Banff Alberta Canada.

Task Force on Promotion and Dissemination of Psychological Procedures, 1995, Training in and dissemination of empirically validated treatments: Report and recommendations, The Clinical Psychologist, 48, 3

10.1192/bjp.186.6.516

10.1037/1040-3590.1.3.207

Verbeke G., 2000, Linear mixed models for longitudinal data

10.1037/0022-006X.61.4.620

10.1001/archgenpsychiatry.2011.147

Westra H. A. Aviram A. Kertes A. Ahmed M. &Connors L.(2009).Manual for coding resistance in CBT for anxiety. Unpublished manual Department of Psychology York University Toronto ON Canada.

10.1016/j.beth.2013.10.002

Thông tin
Thông tin xuất bản

Clinical Psychology and Psychotherapy

Tập 23 Số 3

272-284

Thông tin tác giả