title: Therapist adherence in individual cognitive-behavioral therapy for binge-eating disorder: assessment, course, and predictors.
abstract: While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.
authors.affiliation: Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany. Electronic address: anne.brauhardt@medizin.uni-leipzig.de.
authors.forename: Anne
authors.initials: A
authors.lastname: Brauhardt
authors.affiliation: Hannover Medical School, Department of Psychosomatic Medicine and Psychotherapy, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Electronic address: dezwaan.martina@mh-hannover.de.
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.affiliation: LWL University Clinic, Ruhr-University Bochum, Department of Psychosomatic Medicine and Psychotherapy, Alexandrinenstrasse 1-3, 44791 Bochum, Germany. Electronic address: stephan.herpertz@rub.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Herpertz
authors.affiliation: Tübingen Medical University Hospital, Psychosomatic Medicine and Psychotherapy, Osianderstrasse 5, 72076 Tübingen, Germany. Electronic address: stephan.zipfel@med.uni-tuebingen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: University of Freiburg, Department of Clinical Psychology and Psychotherapy, Engelbergerstrasse 41, 79106 Freiburg, Germany. Electronic address: jennifer.svaldi@psychologie.uni-freiburg.de.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Svaldi
authors.affiliation: Heidelberg Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Electronic address: hans-christoph.friederich@med.uni-heidelberg.de.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Friederich
authors.affiliation: Leipzig University Medical Center, Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Strasse 27, 04103 Leipzig, Germany. Electronic address: anja.hilbert@medizin.uni-leipzig.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Hilbert
mesh_terms: D000328:Adult; D056912:Binge-Eating Disorder / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D011594:Psychometrics; D016896:Treatment Outcome
keywords: Binge-eating disorder; Cognitive-behavioral therapy; Patient characteristics; Therapeutic alliance; Therapist adherence; Therapist characteristics