Faculty Proceedings, Presentations, Speeches and Lectures


Assessing Therapist Adherence and Competence in Delivering Videoconferenced Group Cognitive Behavioral Stress Management: Adaptation and Application of a RAND Corporation Fidelity Coding System

Event Title

ABCT (Association for Behavioral and Cognitive Therapies) 2020 54th Annual Convention

Event Location


Document Type


Presentation Date


Date Range

2020-11-17 to 2020-11-22


The development of psychotherapeutic interventions is allocated a substantial portion of funding and effort in psychological research. Efficacious interventions, however, beg the question of treatment fidelity as well as feasibility in terms of dissemination, particularly to individuals in lower socioeconomic strata. In addition to consideration of therapy format (e.g., group versus individual) and delivery (e.g., remote versus in-person) to facilitate dissemination, distilling effective therapies into their active ingredients would allow for more efficient delivery of treatment as well as for the monitoring of treatment fidelity. Although validated rating systems for manual adherence and therapist competence do exist, they typically focus on individual therapy and are often inappropriate for the structure of group therapy. To address this limitation, the RAND Corporation derived a Fidelity Coding Guide from existing, validated measures to assess therapist adherence and competence in audio-recorded sessions of group Cognitive Behavioral Therapy (CBT) for symptoms related to depression and substance abuse in the BRIGHT and BRIGHT-2 interventions. Adherence items are structured to allow for the diverse content of individual sessions, and competence items include, for example, Collaboration and Group Participation, which are particularly relevant to group therapy. We modified this coding system for applicability to video sessions (by adding a Physical Presence competence item) and to Cognitive Behavioral Stress Management (CBSM), a type of CBT that has been shown to modulate neuroimmune processes and psychological outcomes in several chronic illness populations. Using this modified system, two clinical psychology pre-doctoral graduate students coded 146 videos of a 10-week CBSM program for patients with Chronic Fatigue Syndrome and their partners, and ~40% of sessions were double-coded to assess interrater reliability. Across all 8 therapist adherence items (rated 0-3) and 15 therapist competence items (rated 0-6), very good interrater reliability was achieved (weighted k=0.926), with very good reliability for adherence items (weighted k=0.929) and good reliability for competence items (weighted k=0.784). All but three items met the a priori designated weighted kappa cutoff of greater-than-moderate agreement (i.e., >0.60): agreements for Bridge from Previous Visit, Comprehension, and Group Motivation were in the moderate range (weighted k's=0.587, 0.572, and 0.421 respectively), and these items may benefit from more extensive operationalization. Nevertheless, our successful adaptation and application of the RAND Fidelity Coding Guide supports the feasibility of using this system for a diverse range of group therapies. As the field recognizes the science-practice gap and aims to allow real individuals to benefit from the wealth of knowledge reported in our literature, questions of dissemination, and therefore fidelity, are of paramount importance. The use of flexible coding systems, such as this adaptation of the RAND Fidelity Coding System, provides a means to address these questions.