An assessment method comparison study of clinician adherence to cognitive processing therapy for posttraumatic stress disorder

There is variability in the extent to which clinicians providing evidence-based psychotherapies (EBPs) adhere to key elements in the interventions. A number of studies indicate that clinician fidelity (i.e., adherence to, and competence in, delivering prescribed interventions) to EBPs is associated with better patient outcomes, and is considered critical to successful disseminationvefforts. Assessing fidelity traditionally involves trained expert observers who rate recordedvtherapy sessions, but the high cost and time intensive nature of this rigorous method is a majorvbarrier to knowledge translation, and is not feasible in routine clinical settings. An alternative method of fidelity assessment may be clinicians’ self-reported fidelity, but the validity of thismethod is lacking in the literature more generally, and specifically with regard to posttraumatic stress disorder (PTSD). The current study examined two methods of assessing clinician adherence to Cognitive Processing Therapy (CPT) for PTSD, and their association to patient-reported PTSD symptomatology in a randomized controlled hybrid effectiveness-implementation 

trial. It also sought to identify key components of fidelity by elucidating elements of adherence to CPT. A total of 647 expert-assessed ratings and 371 clinician self-reported ratings of therapy sessions delivered by community clinicians (n = 53) to patients with PTSD (n = 195) were

included. Results indicated that relative to expert raters, clinicians were able to accurately evaluate their own adherence to CPT. Higher adherence in both measures were independently associated with reductions in patient-reported PTSD symptoms over the course of treatment.

Current findings suggested that clinician-reported fidelity may be an alternative or supplement to traditional observer-reported methods of fidelity assessment, especially in community settings.

Keywords: treatment adherence, fidelity to treatment, rater agreement, self-reported fidelity, evidence-based treatment, Cognitive Processing Therapy, posttraumatic stress disorder