title: Therapy contamination as a measure of therapist treatment adherence in a trial of cognitive behaviour therapy versus befriending for psychosis.
abstract: BACKGROUND
  High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis.
  
  
  OBJECTIVE
  The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS).
  
  
  METHODS
  Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM.
  
  
  RESULTS
  Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group.
  
  
  CONCLUSIONS
  The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bendall
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Allott
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Martina
authors.initials: M
authors.lastname: Jovev
authors.affiliation: Centre Hospitalier Universitaire de Quebec,Canada.
authors.forename: Marie-Josee
authors.initials: MJ
authors.lastname: Marois
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Eoin J
authors.initials: EJ
authors.lastname: Killackey
authors.affiliation: Australian Catholic University,Melbourne,Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Gleeson
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Mario
authors.initials: M
authors.lastname: Alvarez-Jimenez
authors.affiliation: Orygen Youth Health Research Centre,andUniversity of Melbourne,Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: University of Melbourne,Australia.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards
keywords: contamination