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维度，这些维度有助于社交焦虑障碍的认知治疗在临床实践中取得积极结果。研究表明，遵守手册和治疗能力(根据治疗的实际情况灵活调整手册)是治疗师的核心因素。此外，治疗联盟和共同因素被认为是影响结果的主要因素。尽管在对照研究环境下的试验中有一些证据支持这些假设，但目前还没有关于临床实践环境中治疗师因素在治疗社交焦虑障碍中的作用的数据。计划中的分析基于一项研究的数据，该研究涉及一种基于手动治疗方法的有效性，即社交焦虑症的认知疗法。在这项研究中，49名心理治疗师被随机安排接受基于手动认知疗法的控制条件培训(没有特定的培训)。共有166名患者被准随机分配到两种治疗条件之一的治疗中。采用Liebowitz社交焦虑量表(LSAS)评定治疗结果。已完成116项治疗，目前正在分析结果。在拟议的附加研究中，将根据治疗的录音带分析训练有素的治疗师和未接受培训的治疗师的依从性、能力、共同因素和治疗联盟。此外，还将分析这些因素对治疗结果预测的贡献。治疗者的行为将由已经接受过研究选择的一些评级标准培训的评分员进行评估。研究结果可能有助于改进训练方法和治疗手册，以便在临床实践中优化治疗师的训练和社交焦虑障碍患者的治疗。

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.