The Assessment of Treatment Integrity in a Cognitive Behavioral Telephone Intervention Study With Dementia Caregivers

Assessment of treatment integrity, such as therapists' adherence and competence, is essential for the development and evaluation of evidence-based therapeutic interventions, but in most intervention studies proof of treatment integrity has not been considered on a regular basis. One reason is that there is a lack of appropriate assessment instruments. For dementia caregiver trials treatment adherence and competence scales do not exist. To evaluate treatment integrity in a cognitive behavioral therapy (CBT) telephone intervention with dementia caregivers, we developed a new adherence scale and adapted the Cognitive Therapy Scale (CTS) for CBT with dementia caregivers. We also analyzed whether CBT can be delivered with treatment integrity for interventions with dementia caregivers and by telephone. Eighty-six entire sessions with 45 caregivers in a randomized-controlled intervention study were judged by four independent raters. Inter-rater reliability was high for overall score on the adherence scale (intraclass correlation [ICC] = .85) and the CTS (ICC = .82). Overall adherence was moderate and competence was high. Both scales proved to be reliable; thus they can be used for assessing treatment integrity in other research fields with dementia caregivers, including measuring the impact of treatment on outcome criteria. The results also reveal that CBT can be delivered with adherence to the manual and competently to dementia caregivers and by telephone, opening up new options for future research and practice.