Background

Developmentally adapted cognitive processing therapy (D-CPT) is an effective treatment for posttraumatic stress disorder (PTSD) in adolescents and young adults. It is unclear if therapeutic adherence and competence in D-CPT are associated with higher PTSD treatment gains.

Objective

To assess if higher therapeutic adherence and competence in D-CPT are associated with higher symptom reduction of PTSD in adolescents and young adults, while controlling for therapeutic alliance.

Participants and setting

Participants were 38 patients (aged 14–21 years; M = 17.61 years, SD = 2.42 years) of a multicenter randomized controlled trial in which the efficacy of D-CPT was compared to a waitlist with treatment advice.

Methods

Videotaped therapy sessions were rated using validated ratings scales to assess adherence and competence. Therapeutic alliance was assessed via weekly patient ratings. We used hierarchical linear modelling to assess the relationship of adherence and competence on PTSD symptoms being measured by both clinician and patient while controlling for alliance.

Results

Neither adherence nor competence were related to treatment outcomes in clinician or patient rated PTSD symptom severity. Higher alliance was associated with a lower symptom severity at 12 months posttreatment in both clinician and patient rated PTSD symptoms.

Conclusions

In this study of young adults with PTSD, who were treated with D-CPT by well-trained therapists, therapeutic adherence and competence were not related to treatment outcome. This might be explained by a lack of range in therapist adherence and competence. Therapeutic alliance had a positive effect on PTSD symptom severity.

中文翻译：

---

治疗能力、依从性和联盟对接受发育适应性认知处理疗法治疗的 PTSD 青少年治疗结果的影响

背景

发育适应性认知处理疗法 (D-CPT) 是治疗青少年和年轻人创伤后应激障碍 (PTSD) 的有效方法。目前尚不清楚 D-CPT 的治疗依从性和能力是否与更高的 PTSD 治疗收益相关。

客观的

评估 D-CPT 中较高的治疗依从性和能力是否与青少年和年轻人 PTSD 症状减少有关，同时控制治疗联盟。

参与者和设置

 参与者是一项多中心随机对照试验的38 名患者（年龄 14-21 岁；M  = 17.61 岁，SD = 2.42 岁），在该试验中将 D-CPT 的疗效与带有治疗建议的候补名单进行了比较。

方法

使用经过验证的评分量表对录像治疗课程进行评分，以评估依从性和能力。治疗联盟通过每周患者评分进行评估。我们使用分层线性模型来评估依从性和能力对临床医生和患者测量的 PTSD 症状的关系，同时控制联盟。

结果

依从性和能力都与临床医生或患者评估的 PTSD 症状严重程度的治疗结果无关。在临床医生和患者评估的 PTSD 症状中，较高的联盟与治疗后 12 个月的较低症状严重程度相关。

结论

在这项由训练有素的治疗师接受 D-CPT 治疗的患有 PTSD 的年轻成人的研究中，治疗依从性和能力与治疗结果无关。这可能是因为治疗师的依从性和能力缺乏范围。治疗联盟对 PTSD 症状严重程度有积极影响。