A glimpse into the "black box": which elements of the EBP consultation relate to changes in client symptoms and therapist fidelity?

First published November 1, 2021 Research Article

Available at: https://doi.org/10.1177/263348952110517

Commentary

Consultations are considered to improve the delivery and clinical outcomes of cognitive processing therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD), but little is known about specific components.

This study was investigating whether specific activities conducted during a CPT consultative meeting were associated with increased fidelity to CPT protocols for 60 newly trained therapists and improved clinical outcomes for 135 clients treated by these therapists.

Consulting activities, which fell into three broad categories (discussion of application of CPT to individual cases, fidelity review/feedback, and technical issues), were measured by a consultant checklist for each consulting session.

Treatment fidelity was assessed by a trained observer on a random sample of therapists' CPT sessions after the consultation. In addition, the self-reported PTSD Checklist-IV assessed changes in PTSD symptoms.

Multilevel regression analysis showed that higher attendance at therapist visits predicted a greater reduction in clients' PTSD symptoms, and that attendance was not associated with observers' treatment fidelity.

The application of a specific CPT strategy was the only consultation activity that was significantly associated with significant improvement in PTSD symptoms.

Finally, no consultation activity was significantly associated with treatment fidelity.