Effect of therapeutic competence, adherence, and alliance on treatment outcome in youth with PTSD treated with developmentally adapted cognitive processing therapy

  • Background: Developmentally adapted cognitive processing therapy (D-CPT) is an effective treatment for posttraumatic stress disorder (PTSD) in adolescents and young adults. It is unclear if therapeutic adherence and competence in D-CPT are associated with higher PTSD treatment gains. Objective: To assess if higher therapeutic adherence and competence in D-CPT are associated with higher symptom reduction of PTSD in adolescents and young adults, while controlling for therapeutic alliance. Participants and setting: Participants were 38 patients (aged 14–21 years; M = 17.61 years, SD = 2.42 years) of a multicenter randomized controlled trial in which the efficacy of D-CPT was compared to a waitlist with treatment advice. Methods: Videotaped therapy sessions were rated using validated ratings scales to assess adherence and competence. Therapeutic alliance was assessed via weekly patient ratings. We used hierarchical linear modelling to assess the relationship of adherence and competence on PTSD symptoms being measured by both clinician and patient while controlling for alliance. Results: Neither adherence nor competence were related to treatment outcomes in clinician or patient rated PTSD symptom severity. Higher alliance was associated with a lower symptom severity at 12 months posttreatment in both clinician and patient rated PTSD symptoms. Conclusions: In this study of young adults with PTSD, who were treated with D-CPT by well-trained therapists, therapeutic adherence and competence were not related to treatment outcome. This might be explained by a lack of range in therapist adherence and competence. Therapeutic alliance had a positive effect on PTSD symptom severity.

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Author:Regina SteilORCiDGND, Judith WeißORCiD, Babette RennebergORCiDGND, Jana GutermannGND, Rita RosnerORCiDGND
Parent Title (English):Child Abuse & Neglect
Place of publication:Amsterdam
Document Type:Article
Date of Publication (online):2023/05/11
Date of first Publication:2023/05/11
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/10/13
Tag:Child and adolescent psychotherapy; Developmentally adapted cognitive processing therapy; Posttraumatic stress disorder; Therapeutic adherence; Therapeutic competence
Page Number:9
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY-NC-ND - Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International