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Using technology to understand how therapist variables are associated with clinical outcomes in IAPT

Published online by Cambridge University Press:  28 July 2020

S.E. Bateup Open the ORCID record for S.E. Bateup [Opens in a new window] ,
C.R. Palmer  and
A. Catarino
S.E. Bateup*
Affiliation:
Ieso Digital Health, Cambridge, UK
C.R. Palmer
Affiliation:
Centre for Applied Medical Statistics, University of Cambridge, Cambridge, UK
A. Catarino
Affiliation:
Ieso Digital Health, Cambridge, UK
*
*Corresponding author. Email: [email protected]
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Abstract

The UK’s Improving Access to Psychological Therapy Programme (IAPT) has improved transparency of primary mental health care in relation to the mandatory reporting of clinical outcomes. However, the data reveal a significant variance in outcomes. These findings have led to a growing body of research investigating to what extent therapist variables account for the difference in clinical outcomes. Previous studies have not had access to sufficient recordings or transcripts of therapy sessions in order to fully address this question. The purpose of this study was to use therapy transcripts derived from internet enabled cognitive behavioural therapy (CBT) treatment sessions in order to investigate whether and how therapist variables are associated with clinical outcome. A hierarchical log-linear analysis examined the relationship between therapist/patient variables and clinical outcome. Therapist fidelity to the CBT model and associated adherence to an evidence-based protocol were significantly related to clinical outcome. A graphical representation of the statistical model suggests that patient recovery is directly linked with fidelity and indirectly with adherence, after adjusting for patient attributes of age, gender and clinical presentation. Corroborating previous research, therapist competence and adherence to an evidence-based treatment protocol appear to be important in improving outcomes. These findings have implications for the continuing professional development of qualified therapists, potentially reinforcing the importance of reducing therapist drift.

Key learning aims

  1. (1) To develop an understanding in relation to which therapist variables are associated with clinical outcome in IAPT.

  2. (2) To reflect on how fidelity to the CBT model and adherence to evidence-based treatment protocols may affect clinical outcomes.

  3. (3) To exemplify use of a statistical method for enhanced visual understanding of complex multi-factorial data.

Keywords

CBTcompetencyIAPToutcometherapist variables
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e26
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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Footnotes

‡

Current address: 24 Bullen Close, Cambridge CB1 8YU, UK

References

Further reading

Castonguay, L. G., & Hill, E. (2017). Why and How are Some Therapists Better Than Others: Understanding Therapist Effects. Washington DC, USA: American Psychological Association.CrossRefGoogle Scholar
Waller, G., & Turner, H. (2016). Therapist drift-redux: why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track. Behaviour Research and Therapy, 77, 129–137. doi: 10.1016/j.brat.2015.12.005CrossRefGoogle ScholarPubMed

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