Competence-feedback and Therapy Outcome

The Importance of Competence-feedback for Therapy Outcome: a Randomized Controlled Trial

In a randomized controlled study design, n = 58 treatments of patients with depression were to be conducted under a feedback-condition, in which the therapist would receive feedback five times within 20 treatment sessions. The competence-feedback includes detailed feedback about 14 different aspects of therapist behavior. The control group includes n = 58 further treatments within which therapists do not receive any competence-feedback (treatment as usual; TAU).

Study Overview

• Status: Completed
• Conditions: Depression
• Intervention / Treatment: Behavioral: competence-feedback; Other: control

Detailed Description

Psychotherapeutic competencies are considered to be an important factor for therapy success. However, empirical studies which have investigated the competence-outcome relationship were only based on correlational analyses. Therefore, these studies are inappropriate for the investigation of causal relationships. In previous studies, feedback on therapists' competencies was found to be suitable for enhancing such competencies. Therefore, in the current research project, competence-feedback should be used to enhance therapeutic competencies systematically, in order to investigate the causal impact of these competencies on therapy outcome. Using a randomized controlled study design, n = 58 treatments of patients with depression were to be conducted under a feedback-condition, in which the therapist would receive feedback five times within 20 treatment sessions. The competence-feedback includes detailed feedback about 14 different aspects of therapist behavior. The control group includes n = 58 further treatments within which therapists do not receive any competence-feedback (treatment as usual; TAU). In order to ensure comparability of both treatment conditions (regarding an observation situation), the therapists in the TAU condition should also receive feedback, but only after the treatments are finished. We hypothesize that the feedback-group is superior to the TAU-group and that their treatments lead to significantly better therapy outcome. Moreover, we use mediator analysis to analyze whether the group-outcome relationship is mediated by therapeutic competencies or by the quality of the therapeutic alliance. The results are highly relevant for clinical process research, psychotherapy training and for the dissemination of treatment approaches in routine care.

• Study Type: Interventional
• Enrollment (Actual): 114
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Germany
  • Mainz, Germany, 55122
    • Johannes Gutenberg University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

THERAPISTS

Inclusion Criteria:

• Having successfully completed the interim Audit
• Having started to treat ambulant patients

Exclusion Criteria:

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PATIENTS

Inclusion Criteria:

• Clinical diagnosis of Major Depression (Meeting DSM-IV criteria)
• Informed consent

Exclusion Criteria:

• Suicidal tendency
• Clinical diagnosis of alcohol or drug addiction, acute schizophrenia, schizoaffective disorder or bipolar disorder
• Clinical diagnosis of personality disorder cluster A (odd disorders) and B (dramatic, emotional or erratic)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: competence-feedback; Therapists assigned to this group will receive standardized feedback on their psychotherapeutic competency after every fourth treatment session with a patient for a period of 20 therapy sessions. The feedback will be given by two experienced raters who are licensed as psychological psychotherapists.	Behavioral: competence-feedback; competence-feedback
Placebo Comparator: control; Therapists assigned to this group will receive no competence-feedback.	Other: control; control group without competence-feedback

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Beck Depression Inventory II (BDI II)	self-report measure to assess depressive symptoms	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Client Satisfaction Questionaire (CSQ8)	self-report measure to assess satisfaction with therapy	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Health-related quality of life (SF-12)	self-report measure to assess health-related quality of life	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Hamilton Depression Scale (HAMD-17)	external assessment to assess depressive symptoms	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Inventory of Interpersonal Problems (IIP-C)	self-report instrument to identify a person's salient interpersonal difficulties based on the interpersonal circumplex model	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Cognitive Therapy Scale (CTS)	external-assessment measure that assesses psychotherapeutic competency during a cognitive therapy session. CTS will be used by two trained raters licensed as psychological psychotherapists	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Helping Alliance Questionaire (HAQ)	self-report measure to assess therapeutic alliance from the therapists perspective (therapist version; HAQ-T), the patients perspective (HAQ-P) and the raters perspective (HAQ-R)	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks
Assessment of Patient Interpersonal Behavior (AFPIB)	assessment of patient in-session interpersonal behavior	participants will be followed for the duration of psychotherapy, an expected average of 20 weeks

Collaborators and Investigators

• Sponsor: Johannes Gutenberg University Mainz
• Collaborators: University of Potsdam
• Investigators: Study Director: Florian Weck, PhD, University of Potsdam

Publications and helpful links

General Publications

• Weck F, Junga YM, Kliegl R, Hahn D, Brucker K, Witthoft M. Effects of competence feedback on therapist competence and patient outcome: A randomized controlled trial. J Consult Clin Psychol. 2021 Nov;89(11):885-897. doi: 10.1037/ccp0000686.

Study record dates

Study Major Dates

• Study Start: August 1, 2015
• Primary Completion (Actual): September 1, 2020
• Study Completion (Actual): September 1, 2020

Study Registration Dates

• First Submitted: June 19, 2015
• First Submitted That Met QC Criteria: June 23, 2015
• First Posted (Estimate): June 24, 2015

Study Record Updates

• Last Update Posted (Actual): January 27, 2021
• Last Update Submitted That Met QC Criteria: January 26, 2021
• Last Verified: January 1, 2021

More Information

Terms related to this study

• Keywords: competence-feedback
• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: WE_01; WE 4652/7-1 (Other Grant/Funding Number: German Research foundation)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO