To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.

在一项随机对照试验中检查治疗保真度，该试验将针对有焦虑的青少年分组进行的以学校为基础的认知行为疗法 (CBT)。我们调查了依从性和能力是否 (a) 在短期和标准长度的 CBT 中有所不同，以及 (b) 依从性和能力是否预测了焦虑症状和障碍的变化。方法：使用CBT 治疗青少年焦虑症的能力和依从性量表对会议进行观察编码。编码员 ( N  = 7) 对来自 52 个小组的 104 次会议进行了评级，这些会议由 32 位主持人（M年龄 = 43.2 岁，SD  = 8.1）提供给 295 名青年（M年龄 = 14.0 岁，SD = 0.8）。结果是青少年和家长报告的干预后和 1 年随访时的焦虑症状和障碍。线性混合效应模型用于分析保真度是否预测临床结果。结果：两个项目的依从性和能力水平都足够，但与标准长度的 CBT 相比，总体而言更高，分别为p < .001 和p = .010）。在任何时间点，依从性和能力都不能预测临床结果。结论：在简短的 CBT 中更高水平的依从性和能力表明，新手 CBT 提供者可能更容易在简化和不太灵活的干预中实现保真。与预期相反，依从性和能力不能预测临床结果。