Entwicklung und Validierung von Instrumenten zur Überprüfung der therapeutischen Adhärenz und Kompetenz bei der Behandlung der Panikstörung

Interactions with Standardized Patients to Evaluate Students’ Psychotherapy-Competencies

Abstract. The use of standardized patients (SPs) in the training of prospective practitioners is a well-established didactic tool in medical schools. Only recently have simulations of patients in psychotherapy been introduced into the training of psychologists. By integrating psychotherapy training into university-level master’s programs, German law now requires licensing exams for psychotherapists (i. e., Approbationsprüfung) to include an assessment of therapeutic competencies in simulated interactions with SPs. Yet, it has not been examined whether these simulations are useful for a reliable assessment of competencies in psychotherapy trainees. Also, we need to develop standardized instruments to evaluate competencies in entry-level psychotherapists. As part of a university course, we trained master’s-level students from three cohorts in clinical interviewing techniques (course title: Klinisch-psychologische Gesprächsführung). We analyzed videotaped 20-min sequences of N = 104 students while they interviewed one of N = 38 trained SPs. The students’ task was to interview the SP, conduct a brief case history, and use the interviewing skills they had learned in class. Two independent raters evaluated their psychotherapeutic competencies with an adapted version of the German Cognitive Therapy Scale (CTS). Raters evaluated students’ performance on two subscales and the total score with satisfactory interrater agreement (intraclass correlations). In general, students performed well in the interviews: They structured the sessions sufficiently, and their global psychotherapeutic competencies were satisfactory. However, the psychotherapeutic competencies of master’s students fell short of the benchmark derived from experienced psychotherapists. This pilot study provides first evidence that simulated interviews with SPs may be a reliable tool in the assessment of practical competencies in psychotherapy trainees at an early stage of their training. Moreover, we found that the CTS, which has demonstrated validity to quantify competencies of psychotherapists, is applicable and reliable in this training context as well. In sum, this suggests that simulated interviews with SPs may be useful for evaluating psychotherapeutic competencies of psychotherapy trainees.

Assessing panic disorder-specific competencies: evaluation of the Cognitive Therapy Competence Scale for panic disorder

BACKGROUND

Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures.

AIMS

To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Competence Scale (CTCP) for panic disorder.

METHOD

CBT trainees (n = 60) submitted audio recordings of CBT for panic disorder that were scored on a generic competence measure, the Cognitive Therapy Scale - Revised (CTS-R), and the CTCP by markers with experience in CBT practice and evaluation. Trainees also provided pre- to post-treatment clinical outcomes on disorder-specific patient report measures for cases corresponding to their therapy recordings.

RESULTS

The CTCP exhibited strong internal consistency (α = .79-.91) and inter-rater reliability (ICC = .70-.88). The measure demonstrated convergent validity with the CTS-R (r = .40-.54), although investigation into competence classification indicated that the CTCP may be more sensitive at detecting competence for panic disorder-specific CBT skills. Notably, the CTCP demonstrated the first indication of a relationship between therapist competence and clinical outcome for panic disorder (r = .29-.35); no relationship was found for the CTS-R.

CONCLUSIONS

These findings provide initial support for the reliability and validity of the CTCP for assessing therapist competence in CBT for panic disorder and support the use of anxiety disorder-specific competence measures. Further investigation into the psychometric properties of the measure in other therapist cohorts and its relationship with clinical outcomes is recommended.

The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia

Treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) are considered to be important for cognitive behavioral therapy (CBT) for panic disorder and agoraphobia (PD/AG). In the current study, four independent raters conducted process evaluations based on 168 two-hour videotapes of 84 patients with PD/AG treated with exposure-based CBT. Two raters evaluated patients' interpersonal behavior in Session 1. Two raters evaluated treatment delivery factors in Session 6, in which therapists provided the rationale for conducting exposure exercises. At the 6-month follow-up, therapists' adherence (r=0.54) and therapeutic alliance (r=0.31) were significant predictors of changes in agoraphobic avoidance behavior; therapist competence was not associated with treatment outcomes. Patients' interpersonal behavior in Session 1 was a significant predictor of the therapeutic alliance in Session 6 (r=0.17). The findings demonstrate that treatment delivery factors, particularly therapist adherence, are relevant to the long-term success of CBT for PD/AG.