OBJECTIVE Although Dialectical Behavior Therapy (DBT) is a well-established evidence-based psychotherapy, little is known about the role of therapist adherence in promoting positive outcomes. This study evaluated the temporal relationships between therapist adherence to DBT and patient outcomes, as well as potential moderators of these relationships. METHOD Data were from six clinical trials conducted in research and community settings with a variety of patient populations. In these trials, trained observers rated 83 therapists for adherence during 1,262 DBT individual therapy sessions with 288 patients. Patient outcomes included suicide attempts, nonsuicidal self-injury (NSSI), treatment dropout, psychiatric hospitalizations, and global functioning. Longitudinal mixed-effects models evaluated the time-ordered, bidirectional relationships between adherence and outcomes. RESULTS Higher therapist adherence significantly predicted fewer subsequent suicide attempts (p = .002, η = 0.32) and a lower risk of dropout (p = .002, η = 0.33), and the latter relationship was strongest among patients with comorbid opioid dependence. Higher therapist adherence predicted fewer subsequent hospitalizations among community therapists (p = .001, η = 0.35) and patients that were not exclusively suicidal/self-injuring (p < .001, η = 0.41). Conversely, more frequent NSSI (p = .03, η = 0.22) and worse global functioning (p = .01, η = 0.26) predicted higher subsequent therapist adherence, and the latter relationship was moderated by patient population. CONCLUSIONS Therapist adherence improves several key patient outcomes and retention, highlighting the importance of delivering DBT with adherence to the manual. Therapists may find it easier to deliver DBT adherently to more severely impaired patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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辩证行为治疗中治疗师依从性与患者结果之间的时间关系。

目的 尽管辩证行为疗法 (DBT) 是一种行之有效的循证心理疗法，但对于治疗师依从性在促进积极结果方面的作用知之甚少。本研究评估了治疗师对 DBT 的依从性与患者结果之间的时间关系，以及这些关系的潜在调节因素。方法 数据来自在研究和社区环境中针对不同患者群体进行的六项临床试验。在这些试验中，训练有素的观察员在 288 名患者的 1,262 次 DBT 个人治疗期间对 83 名治疗师的依从性进行了评分。患者结局包括自杀未遂、非自杀性自伤 (NSSI)、治疗退出、精神病住院和整体功能。纵向混合效应模型评估时间顺序，依从性和结果之间的双向关系。结果 更高的治疗师依从性显着预示了更少的后续自杀企图（p = .002，η = 0.32）和更低的辍学风险（p = .002，η = 0.33），并且在合并阿片类药物依赖的患者中，后一种关系最强。更高的治疗师依从性预示着社区治疗师 (p = .001, η = 0.35) 和并非完全有自杀/自残的患者 (p < .001, η = 0.41) 的后续住院次数减少。相反，更频繁的 NSSI (p = .03, η = 0.22) 和更差的整体功能 (p = .01, η = 0.26) 预示着更高的后续治疗师依从性，并且后一种关系受到患者群体的影响。结论 治疗师的依从性改善了几个关键的患者结果和保留率，强调遵守手册交付 DBT 的重要性。治疗师可能会发现更容易将 DBT 粘附到更严重受损的患者身上。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。