Treatment Integrity Concerns in Cognitive Therapy for Depression

With the emergence of manualized treatments in the 1980s, research protocols have focused increasing attention on documenting the integrity of treatment delivery. Two constructs have guided the conceptualization of assessing treatment integrity. The first, adherence, concerns the extent to which therapists adhere to the interventions of a therapy being tested, and measuring which particular interventions are performed. The second, competence, concerns the quality or skill in therapists’ execution of the therapy being tested. This article reviews the development of treatment integrity research for cognitive therapy in depression, and discusses salient issues that have arisen in its assessment. Recommendations for further refining the considerations of adherence and competence in the delivery of cognitive therapy are provided.