title: Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa.
abstract: OBJECTIVE
  To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM).
  
  
  METHODS
  The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants.
  
  
  RESULTS
  The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed.
  
  
  CONCLUSIONS
  The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM.
authors.affiliation: School of Psychology, University of Western Australia, Perth, Western Australia.|Centre for Clinical Interventions, Perth, Western Australia.
authors.forename: Louise J
authors.initials: LJ
authors.lastname: Andony
authors.affiliation: School of Psychology, University of Western Australia, Perth, Western Australia.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tay
authors.affiliation: School of Psychology, University of Western Australia, Perth, Western Australia.
authors.forename: Karina L
authors.initials: KL
authors.lastname: Allen
authors.affiliation: School of Psychology, Flinders University, Adelaide, South Australia.
authors.forename: Tracey D
authors.initials: TD
authors.lastname: Wade
authors.affiliation: School of Medicine, University of Western Sydney, Sydney, New South Wales.
authors.forename: Phillipa
authors.initials: P
authors.lastname: Hay
authors.affiliation: School of Psychology, University of Sydney, Sydney, New South Wales.
authors.forename: Stephen
authors.initials: S
authors.lastname: Touyz
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Virginia V W
authors.initials: VV
authors.lastname: McIntosh
authors.affiliation: Psychological Medicine, King's College London, London, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.affiliation: Psychological Medicine, King's College London, London, United Kingdom.
authors.forename: Ulrike H
authors.initials: UH
authors.lastname: Schmidt
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Fairburn
authors.affiliation: Centre for Clinical Interventions, Perth, Western Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Erceg-Hurn
authors.affiliation: Centre for Clinical Interventions, Perth, Western Australia.
authors.forename: Anthea
authors.initials: A
authors.lastname: Fursland
authors.affiliation: Neuropsychiatric Research Institute, Fargo, North Dakota.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.affiliation: School of Psychology, University of Western Australia, Perth, Western Australia.|Centre for Clinical Interventions, Perth, Western Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Byrne
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D015588:Observer Variation; D010349:Patient Compliance / Q000706:statistics & numerical data; D011594:Psychometrics; D011613:Psychotherapy / Q000379:methods / Q000592:standards*; D015203:Reproducibility of Results; D055815:Young Adult
keywords: CBT-E; MANTRA; SSCM; anorexia nervosa; randomized controlled trial; therapist adherence