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Practitioner competence and clinical outcomes during cognitive behavioural and cognitive-analytic guided self-help for anxiety

Part of: Low Intensity CBT

Published online by Cambridge University Press:  04 December 2024

Niall Power Open the ORCID record for Niall Power [Opens in a new window] ,
Melanie Simmonds-Buckley ,
Jaime Delgadillo ,
Jessica Smithies ,
Charlotte Bee  and
Stephen Kellett
Niall Power*
Affiliation:
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK South West Yorkshire Partnership NHS Foundation Trust, UK
Melanie Simmonds-Buckley
Affiliation:
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK Rotherham Doncaster and South Humber NHS Foundation Trust, UK
Jaime Delgadillo
Affiliation:
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK Rotherham Doncaster and South Humber NHS Foundation Trust, UK
Jessica Smithies
Affiliation:
Pennine Care NHS Foundation Trust, UK
Charlotte Bee
Affiliation:
Pennine Care NHS Foundation Trust, UK
Stephen Kellett
Affiliation:
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK Rotherham Doncaster and South Humber NHS Foundation Trust, UK
*
Corresponding author: Niall Power; Email: niall.power@swyt.nhs.uk
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Abstract

Despite the ubiquity of guided self-help (GSH) interventions in Primary Care psychological services, there have been no previous studies of the relationship between the competence of qualified practitioners and treatment outcomes. This study compared competence-outcome associations in two types of GSH. Competence and clinical outcome measures were drawn from a clinical trial comparing the efficacy of two types of GSH for anxiety disorders, based on cognitive behaviour therapy (CBT-GSH) or cognitive analytic therapy (CAT-GSH). These interventions were delivered over the telephone by qualified and supervised practitioners. Audio-recordings of GSH sessions (n=94) were rated using a validated competence measure. Clinical outcomes were anxiety, depression and functioning. Secondary outcomes were attendance and need for further intervention after GSH. Competence ratings were highly reliable. No significant associations were found between competence and clinical outcomes, treatment engagement or need for further intervention. In this clinical trial, GSH competence ratings were not associated with clinical outcomes. Directions for future competence-outcome research are provided for GSH interventions.

    Key learning aims

  1. (1) Become familiar with the current empirical literature on therapist competence and associations with clinical outcome.

  2. (2) Raise awareness of a recently developed alternative form of guided self-help based on the theory and principles of cognitive analytic therapy.

  3. (3) Enhance understanding of the relationship between practitioner competence and clinical outcome in guided self-help for anxiety disorders.

Keywords

adherencecompetenceguided self-helpprocess-outcome

Information

Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 17 , 2024 , e40
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Kellett, S., Bee, C., Smithies, J., Aadahl, V., Simmonds-Buckley, M., Power, N., … & Delgadillo, J. (2023). Cognitive-behavioural versus cognitive-analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial. British Journal of Psychiatry, 1–8. https://doi.org/10.1192/bjp.2023.78 Google ScholarPubMed

References

Ali, S., Rhodes, L., Moreea, O., McMillan, D., Gilbody, S., Leach, C., Lucock, M., Lutz, W., & Delgadillo, J. (2017). How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behaviour Research and Therapy, 94, 1–8. doi: 10.1016/j.brat.2017.04.006 CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision).Google Scholar
Baguley, C., Farrand, P., Hope, R., Leibowitz, J., Lovell, K., Lucock, M., O’Neill, C., Paxton, R., Pilling, S., Richards, D., Turpin, G., White, J., & Williams, C. (2010). Good Practice Guidance on the use of SelfHelp Materials within IAPT Services. IAPT.Google Scholar
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. https://doi.org/10.1037/0022-006X.56.6.893 CrossRefGoogle ScholarPubMed
Bisseling, E. M., Schellekens, M. P., Spinhoven, P., Compen, F. R., Speckens, A. E., & van der Lee, M. L. (2019). Therapeutic alliance – not therapist competence or group cohesion – contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients. Clinical Psychology & Psychotherapy, 26, 309–318. https://doi.org/10.1002/cpp.2352 CrossRefGoogle ScholarPubMed
Branson, A., Myles, P., Mahdi, M., & Shafran, R. (2018). The relationship between competence and patient outcome with low-intensity cognitive behavioural interventions. Behavioural and Cognitive Psychotherapy, 46, 101–114. https://doi.org/10.1017/S1352465817000522 CrossRefGoogle ScholarPubMed
Branson, A., Shafran, R., & Myles, P. (2015). Investigating the relationship between competence and patient outcome with CBT. Behaviour Research and Therapy, 68, 19–26. https://doi.org/10.1016/j.brat.2015.03.002 CrossRefGoogle ScholarPubMed
Chan, S. W., & Adams, M. (2014). Service use, drop-out rate and clinical outcomes: a comparison between high and low intensity treatments in an IAPT service. Behavioural and Cognitive Psychotherapy, 42, 747–759. doi: 10.1017/S1352465813000544 CrossRefGoogle Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. https://doi.org/10.1037/0033-2909.112.1.155 CrossRefGoogle ScholarPubMed
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. https://doi.org/10.1007/BF02310555 CrossRefGoogle Scholar
Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943–1957. https://doi.org/10.1017/S0033291710000772 CrossRefGoogle ScholarPubMed
Delgadillo, J., Branson, A., Kellett, S., Myles-Hooton, P., Hardy, G. E., & Shafran, R. (2020). Therapist personality traits as predictors of psychological treatment outcomes. Psychotherapy Research, 30, 857–870. https://doi.org/10.1080/10503307.2020.1731927 CrossRefGoogle ScholarPubMed
Delgadillo, J., Kellett, S., Ali, S., McMillan, D., Barkham, M., Saxon, D., … & Lucock, M. (2016). A multi-service practice research network study of large group psychoeducational cognitive behavioural therapy. Behaviour Research and Therapy, 87, 155–161. https://doi.org/10.1016/j.brat.2016.09.010 CrossRefGoogle Scholar
Firth, N., Barkham, M., Kellett, S., & Saxon, D. (2015). Therapist effects and moderators of effectiveness and efficiency in psychological wellbeing practitioners: a multilevel modelling analysis. Behaviour Research and Therapy, 69, 54–62. https://doi.org/10.1016/j.brat.2015.04.001 CrossRefGoogle ScholarPubMed
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S., & Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 1217–1228. https://doi.org/10.1017/S0033291707000062 CrossRefGoogle ScholarPubMed
Hallam, C., Simmonds-Buckley, M., Kellett, S., Greenhill, B., & Jones, A. (2021). The acceptability, effectiveness, and durability of cognitive analytic therapy: systematic review and meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice, 94, 8–35. https://doi.org/10.1111/papt.12286 CrossRefGoogle ScholarPubMed
Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: an overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8, 23–34. https://doi.org/10.20982/tqmp.08.1.p023 CrossRefGoogle ScholarPubMed
Ho, F. Y. Y., Chan, C. S., Lo, W. Y., & Leung, J. C. Y. (2020). The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: an updated meta-analysis of randomized controlled trials. Journal of Affective Disorders, 265, 287–304. https://doi.org/10.1016/j.jad.2020.01.062 CrossRefGoogle ScholarPubMed
Ho, F. Y. Y., Yeung, W. F., Ng, T. H. Y., & Chan, C. S. (2016). The efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: a systematic review and meta-analysis. Scientific Reports, 6, 29281. https://doi.org/10.1038/srep29281 CrossRefGoogle ScholarPubMed
Jacobson, N. S., Follette, W. C., & Revenstorf, D. (1984). Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15, 336–352. https://doi.org/10.1016/S0005-7894(84)80002-7 CrossRefGoogle Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to denning meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. https://doi.org/10.1037//0022-006x.59.1.12 CrossRefGoogle Scholar
Kellett, S., Bee, C., Aadahl, V., Headley, E., & Delgadillo, J. (2021a). A pragmatic patient preference trial of cognitive behavioural versus cognitive analytic guided self-help for anxiety disorders. Behavioural and Cognitive Psychotherapy, 49, 104–111. https://doi.org/10.1017/S1352465820000442 CrossRefGoogle Scholar
Kellett, S., Bee, C., Smithies, J., Aadahl, V., Simmonds-Buckley, M., Power, N., … & Delgadillo, J. (2023). Cognitive-behavioural versus cognitive-analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial. British Journal of Psychiatry, 1–8. https://doi.org/10.1192/bjp.2023.78 Google ScholarPubMed
Kellett, S., Simmonds-Buckley, M., Limon, E., Hague, J., Hughes, L., Stride, C., & Millings, A. (2021b). Defining the assessment and treatment competencies to deliver low-intensity cognitive behavior therapy: a multi-center validation study. Behavior Therapy, 52, 15–27. https://doi.org/10.1016/j.beth.2020.01.006 CrossRefGoogle ScholarPubMed
Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15, 155–163. https://doi.org/10.1016/j.jcm.2016.02.012 CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004 CrossRefGoogle ScholarPubMed
Marques, L., Valentine, S. E., Kaysen, D., Mackintosh, M. A., Dixon De Silva, L. E., Ahles, E. M., … & Wiltsey-Stirman, S. (2019). Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic: associations with clinical change. Journal of Consulting and Clinical Psychology, 87, 357–369. https://doi.org/10.1037/ccp0000384 CrossRefGoogle Scholar
Meadows, J., & Kellett, S. (2017). Development and evaluation of cognitive analytic guided self-help (CAT-SH) for use in IAPT services. Behavioural and Cognitive Psychotherapy, 45, 266–284. https://doi.org/10.1017/S1352465816000485 CrossRefGoogle ScholarPubMed
Molnar, F. J., Hutton, B., & Fergusson, D. (2008). Does analysis using “last observation carried forward” introduce bias in dementia research?. CMAJ, 179, 751–753. https://doi.org/10.1503/cmaj.080820CrossRefGoogle ScholarPubMed
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464. https://doi.org/10.1192/bjp.180.5.461 CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2020). The Improving Access to Psychological Therapies Manual [version 4]. https://www.england.nhs.uk/wp-content/uploads/2020/05/iapt-manual-v4.pdf Google Scholar
Norrie, J., Davidson, K., Tata, P., & Gumley, A. (2013). Influence of therapist competence and quantity of cognitive behavioural therapy on suicidal behaviour and inpatient hospitalisation in a randomised controlled trial in borderline personality disorder: Further analyses of treatment effects in the BOSCOT study. Psychology and Psychotherapy: Theory, Research and Practice, 86, 280–293. https://doi.org/10.1111/papt.12004 CrossRefGoogle Scholar
Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: analysis of the studies and examination of the associated factors. Journal of Consulting and Clinical Psychology, 75, 829–841. https://doi.org/10.1037/0022-006X.75.6.829 CrossRefGoogle ScholarPubMed
Power, N., Noble, L. A., Simmonds-Buckley, M., Kellett, S., Stockton, C., Firth, N., & Delgadillo, J. (2022). Associations between treatment adherence-competence-integrity (ACI) and adult psychotherapy outcomes: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 90, 427–445. https://doi.org/10.1037/ccp0000736 CrossRefGoogle ScholarPubMed
Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and Longitudinal Modeling Using Stata. STATA Press.Google Scholar
Richards, D. A., & Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: two-year prospective cohort study. Journal of Affective Disorders, 133, 51–60. https://doi.org/10.1016/j.jad.2011.03.024 CrossRefGoogle ScholarPubMed
Shafran, R., Myles-Hooton, P., Bennett, S., & Öst, L. G. (2021). The concept and definition of ‘low intensity’ cognitive behaviour therapy. Behaviour Research and Therapy, 103803. https://doi.org/10.1016/j.brat.2021.103803 CrossRefGoogle ScholarPubMed
Sharpless, B. A., & Barber, J. P. (2009). A conceptual and empirical review of the meaning, measurement, development, and teaching of intervention competence in clinical psychology. Clinical Psychology Review, 29, 47–56. https://doi.org/10.1016/j.cpr.2008.09.008 CrossRefGoogle ScholarPubMed
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., … & Dunbar, G. C. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241. https://doi.org/10.1016/S0924-9338(97)83297-X CrossRefGoogle Scholar
Shek, D. T., & Ma, C. (2011). Longitudinal data analyses using linear mixed models in SPSS: concepts, procedures and illustrations. The Scientific World Journal, 11, 42–76. https://doi.org/10.1100/tsw.2011.2 CrossRefGoogle ScholarPubMed
Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86, 420–428. https://doi.org/10.1037/0033-2909.86.2.420 CrossRefGoogle ScholarPubMed
Simmonds-Buckley, M., Osivwemu, E. O., Kellett, S., & Taylor, C. (2022). The acceptability of cognitive analytic therapy (CAT): meta-analysis and benchmarking of treatment refusal and treatment dropout rates. Clinical Psychology Review, 102187. https://doi.org/10.1016/j.cpr.2022.102187 CrossRefGoogle ScholarPubMed
Simmonds-Buckley, M., Osivwemu, E. O., Kellett, S., & Taylor, C. (2022). The acceptability of cognitive analytic therapy (CAT): meta-analysis and benchmarking of treatment refusal and treatment dropout rates. Clinical Psychology Review, 96, 102187. doi: 10.1016/j.cpr.2022.102187.CrossRefGoogle ScholarPubMed
Singla, D. R., Kohrt, B. A., Murray, L. K., Anand, A., Chorpita, B. F., & Patel, V. (2017). Psychological treatments for the world: lessons from low and middle-income countries. Annual Review of Clinical Psychology, 8, 149–181. doi: 10.1146/annurev-clinpsy-032816-045217 CrossRefGoogle Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle ScholarPubMed
Strunk, D. R., Brotman, M. A., DeRubeis, R. J., & Hollon, S. D. (2010). Therapist competence in cognitive therapy for depression: predicting subsequent symptom change. Journal of Consulting and Clinical Psychology, 78, 429–437. https://doi.org/10.1037/a0019631 CrossRefGoogle ScholarPubMed
Wakefield, S., Kellett, S., Simmonds-Buckley, M., Stockton, D., Bradbury, A., & Delgadillo, J. (2021). Improving Access to Psychological Therapies (IAPT) in the United Kingdom: a systematic review and meta-analysis of 10-years of practice-based evidence. British Journal of Clinical Psychology, 60, 1–37. https://doi.org/10.1111/bjc.12259 CrossRefGoogle ScholarPubMed
Weck, F., Bohn, C., Ginzburg, D. M., & Stangier, U. (2011). Assessment of adherence and competence in cognitive therapy: comparing session segments with entire sessions. Psychotherapy Research, 21, 658–669. https://doi.org/10.1080/10503307.2011.602751 CrossRefGoogle ScholarPubMed
Weck, F., Richtberg, S., Jakob, M., Neng, J. M., & Höfling, V. (2015). Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis). Psychiatry Research, 228, 53–58. https://doi.org/10.1016/j.psychres.2015.03.042 CrossRefGoogle ScholarPubMed
Wray, A., Kellett, S., Bee, C., Smithies, J., Aadahl, V., Simmonds-Buckley, M., & McElhatton, C. (2022). The acceptability of cognitive analytic guided self-help in an Improving Access to Psychological Therapies service. Behavioural and Cognitive Psychotherapy, 50, 493–507. https://doi.org/10.1017/S1352465822000194 CrossRefGoogle Scholar
Wurman, T.V. (2019). Therapist competence in dynamic interpersonal therapy and its association with treatment outcome. Unpublished doctoral dissertation, University College London.Google Scholar
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