A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

ABSTRACT

Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.     

New-born infants' perception of similarities and differences between two- and three-dimensional stimuli

The new-born baby' ability to detect similarities and differences between three-dimensional stimuli and their two-dimensional representations is investigated in three experiments, using both visual preference and habituation procedures. In Expt 1 new-borns strongly preferred (looked more at) complex objects to their photographs. This preference was found with monocular viewing, and suggests that motion parallax is a salient cue in the detection of the differences between the two- and three-dimensional stimuli. The results from Expt 2 support the view that, for the new-born, the differences between objects and their two-dimensional representations are more detectable or salient than their similarities. These conclusions were further supported by the results from the last experiment, using simpler stimuli, although the preference was for the two- rather than the three-dimensional stimuli. The results suggest that studies which use only two-dimensional stimuli may provide only limited information about the course of perceptual development, at least in the first few months from birth.     

Longitudinal associations between impulsivity and lie-telling in childhood and adolescence

Lie-telling and impulsivity levels peak during late childhood to early adolescence and have been suggested to be related. Heightened impulsivity may lead adolescents to lie in favor of short-term benefits without consideration for the potential consequences of deception. The present study assessed longitudinal relations between self-reported impulsivity and lie-telling frequency. Participants from a large-scale longitudinal study (N = 1148; M_age = 11.55, SD = 1.69, 9–15 years at Time 1) reported on their impulsivity (Barratt Impulsiveness Scale) and their frequency of lie-telling to parents, to teachers, to friends, and about cheating across two time points 1 year apart. Cross-lagged path analysis revealed greater impulsivity was associated with more frequent lie-telling to parents, friends, and teachers, and about cheating over time. Our findings demonstrate the role of impulsivity in the development of lie-telling behaviors.

Research Highlights

• Impulsivity predicts lying across time in multiple contexts (to parents, friends, teachers, and about cheating).
• Previous research has demonstrated the role of top-down influences on lie-telling, but the current study suggests that bottom-up processes are also influential.

     

The Role of Hope and Optimism in Suicide Risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.