Development and evaluation of a scale assessing therapist fidelity to guidelines for delivering therapist-assisted Internet-delivered cognitive behaviour therapy
Open accessAbstract
Internet-delivered cognitive behaviour therapy (ICBT) is often accompanied by therapist emails, but there is limited research on the quality of this therapist-assistance. In this study, an ICBT Therapist Rating Scale (ICBT-TRS) was developed and evaluated to assess whether therapist emails showed fidelity to specific therapist behaviours. Using data from a previous ICBT trial for depression and anxiety, the ICBT-TRS was used to rate 706 emails sent by 39 therapists to 91 randomly selected patients. Emails were rated for adherence (absent/present) and quality (inadequate/competent) on the following behaviours: Builds Rapport, Seeks Feedback, Provides Symptom Feedback, Provides Psychoeducation, Facilitates Understanding, Praises Effort, Encourages Practice, Clarifies Administrative Procedures, and Communicates Effectively. Inter-rater reliability was high. Most behaviours were identified as present in 72-100% of emails, with the exception of Provides Symptom Feedback and Facilitating Understanding which were only present in 54 and 61% of emails. The majority of emails were rated as high quality (88-98% of messages). While not related to symptom improvement, ICBT-TRS ratings were higher when patients were more engaged in ICBT (e.g. log-ins) and among therapists who specialized in ICBT or had a background in Psychology. The ICBT-TRS has potential to facilitate ICBT research and clinical training.
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In March 2018, to improve coordination of iCBT, the Unit increased the numbers of therapists working half-to full-time and reduced the numbers of therapists with small caseloads.
“In March 2018, to improve coordination of iCBT, the Unit increased the numbers of therapists working half-to full-time and reduced the numbers of therapists with small caseloads. 22”
From Utilization, Patient Characteristics, and Longitudinal Improvements among Patients from a Provincially Funded Transdiagnostic Internet-delivered Cognitive Behavioural Therapy Program: Observational Study of Trends over 6 Years (2022) · cites this paper as [22]
The Therapist-assistance section (page unavailable) describes therapists in specialized and community clinics, but not a change in staffing. A search for the March 2018 change, half- to full-time therapists, and small caseloads found no passage addressing the claimed decision or its purpose. (LLM, conf=0.75)
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Self-citation
- Authors
- Hadjistavropoulos, H. D., Schneider, L. H., Klassen, K., Dear, B. F., & Titov, N.
- Affiliations
- University of Regina (CA)
- Macquarie University (AU)
- Corresponding author
- Hadjistavropoulos, Heather D.
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2018-04-25
- Volume
- 47
- Issue
- 6
- Pages
- 447-461
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W2801784000
- Cited by
- 61
- References
- 27
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 10 · 2021: 5 · 2020: 10 · 2019: 11 · 2018: 3
- FWCI
- 9.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (293379)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- internet-based cognitive behavioral therapy, therapist fidelity, scale development, depression, anxiety, patient engagement, psychoeducation, inter-rater reliability, therapist training
- MeSH terms
- Patient Health Questionnaire, Therapeutic Alliance, Anxiety Disorders, Depressive Disorder, Feedback, Humans, Patient Education as Topic, Quality of Health Care, Psychotherapeutic Processes, Therapy, Computer-Assisted, Reproducibility of Results, Cognitive Behavioral Therapy, Treatment Outcome, Process Assessment, Health Care, Guideline Adherence, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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