Sticking to the recipe: How do adherence and differentiation to a CBT protocol affect client outcomes in youths with anxiety?

Objective: Understanding the pathways through which treatments work to change symptom and diagnostic outcomes is important to the development and delivery of evidence-based treatments. This study assessed the extent to which adherence (therapist’s delivery of prescribed therapeutic interventions) and differentiation (therapist’s delivery of non-prescribed therapeutic interventions) to Coping Cat, a CBT program, affected client symptom and diagnostic outcomes. Method: The Therapy Process Observational Coding System for Child Psychotherapy – Revised Strategies Scale (McLeod et al., 2015) was used to characterize therapeutic interventions delivered within and outside of the Coping Cat program with youths aged 7-15 receiving treatment in one efficacy (n = 51; 41% female; 84% Caucasian, M age = 10.37) and one effectiveness (n = 17; 56% female, 39% Caucasian, M age = 10.90) trial. Youth- and parent-report symptom checklists and diagnostic interviews were used to assess symptom and diagnostic remission. Multiple hierarchical regression analyses and hierarchical binomial logistic regression were used to investigate the relation between adherence and differentiation and symptom change and remission of principal diagnosis. Results: Neither adherence nor differentiation were significantly related to symptom or diagnostic outcomes. No clear trend emerged, and results were inconsistent across parent and youth report, outcome type, and setting. Conclusion: These results are consistent with past literature. Two interpretations exist: (1) that there is no relation between treatment delivery and outcomes, and (2) that methodological and analytic flaws undercut the ability of the analyses to identify a relation