Cognitive Therapy for Social Anxiety Disorder in clinical practice: the importance of adherence, competence, therapeutic relationship and common factors

本研究的主要目的是确定治疗师的行为，有助于在临床实践中的社交焦虑障碍的认知治疗的积极成果的维度。研究表明，坚持手册和治疗能力（灵活调整手册的实际治疗环境）是治疗师的核心因素。此外，它被认为是治疗联盟和共同因素是重要的结果。虽然有一些证据表明这些假设来自对照研究环境中的试验，但目前还没有关于治疗师因素在临床实践环境中治疗社交焦虑障碍中的作用的数据。计划的分析是基于一项研究的数据，该研究涉及基于手动的治疗方法，社交焦虑症的认知疗法的有效性。在这项研究中，49名心理治疗师被随机分配到一个控制条件下（没有具体的培训），以手动为基础的认知疗法的培训。共有166例患者被准随机分配至两种治疗条件之一的治疗。 使用Liebowitz社交焦虑量表（LSAS）评估治疗结果。已完成116次治疗，目前正在分析结果。在拟定的附加研究中，将根据治疗录音带分析经过培训与未经培训的治疗师的依从性、能力、共同因素和治疗联合。此外，还将分析这些因素对治疗结局预测的贡献。治疗师的行为将由已经接受过本研究所选某些评定量表培训的评定者进行评估。研究结果有助于改进培训方法和治疗手册，从而优化治疗师的培训和社交焦虑障碍患者的临床治疗。

The primary goal of the present study is to identify dimensions of therapists` behavior that contribute to a positive outcome of cognitive therapy for social anxiety disorder in clinical practice. Research has shown that adherence to a manual and therapeutic competences (flexible adjustment of the manual to the actual context of treatment) are central therapist factors. Besides, it is assumed that therapeutic alliance and common factors are of major importance for the outcome. Although there is some evidence for these assumptions from trials in a controlled research setting, there are currently no data on the role of therapists`factors in the treatment of social anxiety disorder in clinical practice settings. The planned analyses are based on data available from a study which refers to the effectiveness of a manual-based treatment approach, cognitive therapy for social anxiety disorder. In this study, 49 psychological psychotherapists were randomised to a training in manual-based cognitive therapy of a control condition (no specific training). A total of 166 patients were quasi-randomized to a treatment within one of both therapist conditions. Treatment outcome was assessed using the Liebowitz Social Anxiety Scale (LSAS). 116 treatments have been completed, and the results are currently analysed. Within the proposed add-on study, adherence, competence, common factors and therapeutic alliance of trained vs. non-trained therapists will be analyzed on the basis of audiotapes from treatments. In addition, the contribution of these factors to the prediction of treatment outcome will be analysed. Therapists` behaviour will be assessed by raters who are already trained in some of the rating scales selected for the study. The results may contribute to the improvement of training methods and treatment manuals, in order to optimize training of therapists and treatment of patients with social anxiety disorder in clinical practice.