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1 Lab Results Student’s Name Instructor Institution Course Date

2 Lab Results Treatment fidelity is a measure of how closely an intervention is followed in practice, and it takes many moving parts to achieve. For a therapy to be carried out with fidelity, it must be carried out accurately and consistently for all clients for the duration of time required. Treatment integrity has also been overlooked in social work involvements studies (Naleppa & Cagle, 2010). Due to its efficacy and low cost, cognitive behavioral therapy is in high demand. According to a review of five publications dedicated to health behavior research, only about 46% of articles included any methods for ensuring patients adhered to their treatments as prescribed (Borrelli et al., 2005). Fidelity evaluation is necessary to guarantee that CBT is implemented as intended in all settings (research, training, and practice). Assessors often use CBT competency ratings to rate therapy sessions and determine adherence. Therapy faithfulness or integrity is the degree to which a psychological therapy is carried out in accordance with its stated goals. More recent clinical psychology articles do seem to address treatment fidelity, but the lack of standardized reporting procedures makes it hard to compare studies (Kechter et al., 2019). Reviewers of a therapist's CBT session could refer to the ACCS as a framework for their observations. The overall quality of the therapy session is measured by adding up the scores for each individual item and calculating the average of those numbers. The purpose of this research is to determine if and how cognitive behavioral therapy (CBT) graduate training, actual therapist usage of CBT procedures, and patient symptom improvement are related.

3 Methods There were 40 therapists involved in the research. The median age was 24.8. There were somewhat more women (52%) than men (47.5%) among the participants. A self-reported questionnaire was filled out by the therapists, in which they detailed their graduate school CBT training, the frequency with which they employ CBT techniques in session, and the progression of their patients' symptoms from the initial evaluation to the last session. There were 3 independent factors. The first factor was the total number of CBT techniques implemented throughout the session. The number of CBT techniques used in therapy sessions was counted to get a sense of this variable's prevalence. CBT study/training time spent in graduate school was the second factor. Therapists' self-reported weekly time spent practicing or studying CBT techniques during graduate school was used to calculate this variable. Finally, symptom progression was included as a factor. Anxiety levels were assessed by having therapists report their patients' scores on the Beck Anxiety Inventory at the beginning and conclusion of treatment. Results First, we evaluated the prediction that more CBT procedures would be employed in sessions if graduate students had more training in CBT. The amount of CBT procedures employed during sessions was inversely related to symptom improvement, refuting the second hypothesis. The third hypothesis was supported by data showing an inverse relationship between graduate training in CBT hours/weeks and symptom shifts seen by patients. Mean time spent per week learning or studying CTB methods in graduate school had been 2.53 hours, with 1.01 Standard Deviation. The average CBT techniques numbers utilized with clients is 3.05, with the

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4 Standard Deviation being 0.93. Lastly, the standard deviation, and mean of the change in client indicators from the recruitment session to the discharge sessions were -9.12 and 4.63, respectively. Mean Standard Deviation 0 0.5 1 1.5 2 2.5 3 hours spent per week during graduate training CBT techniques hours spent per week during graduate training CBT techniques Mean Standard Deviation 0 0.5 1 1.5 2 2.5 3 3.5 Number of CBT strategies currently used with patients Number of CBT strategies cur- rently used with patients

5 Mean Standard Deviation -10 -8 -6 -4 -2 0 2 4 6 Patient symptom change form intake session to final treatment sesssion Patient symptom change form intake session to final treatment sesssion Discussion Evidence suggests that the correlation between therapist CBT training, the specific CBT techniques employed in therapy or patient symptoms change is multifaceted and complex. Research has consistently depicted that the therapist's level of training in CBT is positively linked with patient results ( Karlin et al., 2012 ). Therapists with more intense CBT training tend to achieve better treatment results with their clients. However, it is crucial to note that the relationship can be influenced by different factors, including experience, theoretical orientation and the capability to establish the strongest therapeutic alliances with their clients. The CBT techniques employed during the therapy could also play a bigger role in determining patient symptom change. For example, specific CBT techniques, such as exposure therapy, effectively treat anxiety disorders. The study limitation was the small sample of therapists./

6 References

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7 Borrelli, B., Sepinwall, D., Ernst, D., Bellg, A. J., Czajkowski, S., Breger, R., ... & Orwig, D. (2005). A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. Journal of consulting and clinical psychology , 73 (5), 852. Karlin, B. E., Brown, G. K., Trockel, M., Cunning, D., Zeiss, A. M., & Taylor, C. B. (2012). National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: therapist and patient-level outcomes. Journal of consulting and clinical psychology , 80 (5), 707. Kechter, A., Amaro, H., & Black, D. S. (2019). Reporting of treatment fidelity in mindfulness- based intervention trials: A review and new tool using NIH behavior change consortium guidelines. Mindfulness , 10 , 215-233. Naleppa, M. J., & Cagle, J. G. (2010). Treatment fidelity in social work intervention research: A review of published studies. Research on Social Work Practice , 20 (6), 674-681.

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