The Cognitive Therapy Adherence and Competence Scale (CTACS)

The Cognitive Therapy Adherence and Competence Scale (CTACS)

A novel research instrument, the Cognitive Therapy Adherence and Competence Scale (CTACS), has been created. This instrument utilizes video taped therapy sessions as input into a specific coding system to assess CBT treatments’ effectiveness in clinical settings with high reliability and validity.

The CTACS contains items that assess therapist adherence and competence in CBT for anxiety disorders. Though these measures have not been widely utilized in the field, some studies have demonstrated their predictive value.

Adherence and competence are crucial elements of the treatment process that may have an immense effect on patient outcomes (Barber et al., 2003; Muse and McManus, 2013). Particularly, adherence is a vital aspect of CBT delivery which has been directly connected to its quality.

Competence is the therapist’s capacity to deliver effective CBT to patients, and has been linked with outcome. Unfortunately, research on this has only been limited by studies with small sample sizes (Bjaastad et al., 2018; Hudson et al., 2014; Liber et al., 2010; Podell et al., 2013; Southam-Gerow et al., 2021).

Due to this, it is essential to assess adherence and competence as potential predictors of treatment outcomes and verify whether the scales are reliable. In this study, we evaluated interterrater reliability of the CTACS with student and expert raters using a standardized coding system. Results showed that ICCs for competence items were excellent while those for adherence items were satisfactory.

Additionally, we investigated the relationship between therapist adherence and competence and long-term outcomes for youth with anxiety disorders in community clinics. Furthermore, we explored the interaction effects of adherence and competence on treatment format, baseline symptom severity and formal CBT training of therapists.

To investigate therapist adherence and competence as potential predictors of outcome, we conducted a cross-sectional study involving participants in an randomized trial of individual CBT and group CBT therapy sessions. They completed diagnostic interviews at pre-treatment, anxiety symptom measures at post-treatment and one year follow up, then another diagnostic interview and anxiety symptom measure at long term follow-up (M = 3.9 years post-treatment; SD = 0.8; range: 2.2-5.9 years) after one year had elapsed since initial measurement).

Studies on therapist adherence and competence have yielded mixed results. While most have found some support for these measures as potential predictors, few have demonstrated a strong connection.

Therapist adherence is an essential aspect of treatment, yet often lacks. Thus, it’s essential to assess adherence to therapy protocols and procedures in CBT for anxiety disorders.

We used the CTACS to examine adherence and competence as potential predictors of long-term outcome in a large sample of youth with anxiety disorders treated in community clinics. All therapists’ scores exceeded what is needed for adequate adherence and competence, suggesting these measures can be useful in identifying those needing to improve their therapy adherence.

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