Patients Accompanied by Therapists During Exposure Sessions Have Better Outcomes

Rates of adherence were similar for therapists of completers and drop-outs, approximately 5.5 on an 8-point scale, and higher level of adherence was associated minimally with worse outcomes, Ms. Hauke reported.

The therapists of the completers were significantly less likely to adhere to the protocol if they were assigned to the therapist-present exposure situation, compared with standard CBT (P = .025). Adherence was not, however, associated with outcomes for patients who dropped out. Therapists of patients who dropped out for exposure-related reasons (for example, anxious, not motivated) versus other reasons (for example, organizational problems, symptom improvement, or deterioration) had a strong trend toward lower levels of adherence (P = .05), which became significant after the researchers controlled for years of therapist experience (P = .036).

The findings might suggest “that levels of adherence should be matched with individual patient requirements before implementing a manualized therapy,” she said.

The main point, Ms. Hauke said, is that robust adherence to the CBT manual is not the only important factor in treatment outcome, and other modifiers should be examined.

The authors reported no potential conflicts of interest. The work was funded by the German Federal Ministry of Education and Research.