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Prof Psychol Res Pr. 2017 Feb;48(1):54-61. doi: 10.1037/pro0000100. Epub 2016 Dec 19.

Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation.

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Massachusetts General Hospital, Harvard Medical School.
The Child Study Center at NYU Langone Medical Center.
University of Miami.
Seattle Children's Hospital, University of Washington School of Medicine.
Temple University.
University of Pennsylvania.


The present study examined 115 service providers' adherence to components of cognitive-behavioral therapy (CBT) for youth anxiety prior to training, post workshop training, and after three months of weekly consultation. Adherence was measured using a role-play with a trained actor. We examined differences in individual adherence to CBT components across time and the relationship between number of consultation sessions attended and adherence ratings following consultation. Findings indicated that somatic arousal identification and relaxation were the most used treatment components prior to training. Adherence to all components of CBT increased following workshop training, except the usage of problem-solving. Adherence to problem-solving, positive reinforcement, the identification of anxious self-talk, and the creation of coping thoughts increased following consultation but usage of problem-solving remained low compared to other treatment components. Overall adherence remained less than optimal at the final measurement point. Number of consultation sessions attended predicted post-consultation adherence to identification of somatic arousal, identification of anxious self-talk, and positive reinforcement. Implications include tailoring future training based on baseline levels of adherence and spending more time during training and consultation on underutilized CBT components, such as problem-solving. Limitations of the present study, including how adherence was measured, are discussed. This study adds to the implementation science literature by providing more nuanced information on changes in adherence over the course of training and consultation of service providers.


Evidence-based practice; adherence; cognitive-behavioral therapy; fidelity; training

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