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dc.contributor.authorPower, Niall
dc.contributor.authorFirth, Nick
dc.date.accessioned2022-09-26T12:19:18Z
dc.date.available2022-09-26T12:19:18Z
dc.identifier.citationJournal of Consulting and Clinical Psychology, 90 (5). pp. 427-445. ISSN 0022-006Xen_US
dc.identifier.urihttp://hdl.handle.net/20.500.12904/15793
dc.descriptionAuthor(s) accepted version. 26/09/2022en_US
dc.description.abstractObjective: To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes. Method: The review protocol was pre registered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycINFO, MEDLINE). Random effects meta-analyses were conducted on adherence-outcome, competence-outcome and integrity-outcome relationships. Separate analyses were performed for studies with hierarchical (i.e. patients nested within therapist) versus non-hierarchical study designs. Moderator analyses were performed according to pre defined clinical and methodological features. GRADE assessments rated the quality of each meta analytic comparison. Results: The review identified 62 studies suitable for inclusion (45 adherence outcome, 39 competence-outcome and 7 integrity-outcome effect sizes; N=8,210 across all analyses). No significant adherence-outcome association was found. A small significant positive association was found only in non-hierarchical studies between competence and outcome (r = 0.17, 95% CI [0.07- 0.26], p < 0.001, ~d = .34, GRADE = moderate). Small-to-moderate significant positive associations between integrity and outcome were found for both non-hierarchical (r = 0.15, 95% CI [0.06 – 0.23], p < 0.001, ~d = .30, GRADE = high) and hierarchical study designs (r = 0.23, 95% CI [0.01,0.43], p < 0.044, ~d = .47, GRADE = low). Diagnosis, treatment modality and year of publication significantly moderated the strength of ACI-outcome correlations. Conclusions: Competence and integrity are significantly associated with clinical outcome, with a magnitude comparable to wider common factors. Further research is required to study these process-outcome associations with greater precision in routine-care settings and to understand the role of moderating variables.
dc.description.urihttps://eprints.whiterose.ac.uk/185434/1/ACI-Meta_ACCEPTED_JCCP.pdfen_US
dc.subjectPsychologyen_US
dc.titleAssociations between treatment adherence-competence-integrity (ACI) and adult psychotherapy outcomes : a systematic review and meta-analysis.en_US
dc.typeArticleen_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
rioxxterms.versionNAen_US
rioxxterms.versionofrecordhttps://doi.org/10.1037/ccp0000736en_US
rioxxterms.typeJournal Article/Reviewen_US
refterms.dateFOA2022-09-26T12:19:20Z
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2022
html.description.abstractObjective: To provide a comprehensive assessment of the association between psychological treatment adherence/competence/integrity (ACI) and clinical outcomes. Method: The review protocol was pre registered (CRD42020193889). Studies that assessed ACI-outcome relationships for adult psychotherapy were searched across three databases (Scopus, PsycINFO, MEDLINE). Random effects meta-analyses were conducted on adherence-outcome, competence-outcome and integrity-outcome relationships. Separate analyses were performed for studies with hierarchical (i.e. patients nested within therapist) versus non-hierarchical study designs. Moderator analyses were performed according to pre defined clinical and methodological features. GRADE assessments rated the quality of each meta analytic comparison. Results: The review identified 62 studies suitable for inclusion (45 adherence outcome, 39 competence-outcome and 7 integrity-outcome effect sizes; N=8,210 across all analyses). No significant adherence-outcome association was found. A small significant positive association was found only in non-hierarchical studies between competence and outcome (r = 0.17, 95% CI [0.07- 0.26], p < 0.001, ~d = .34, GRADE = moderate). Small-to-moderate significant positive associations between integrity and outcome were found for both non-hierarchical (r = 0.15, 95% CI [0.06 – 0.23], p < 0.001, ~d = .30, GRADE = high) and hierarchical study designs (r = 0.23, 95% CI [0.01,0.43], p < 0.044, ~d = .47, GRADE = low). Diagnosis, treatment modality and year of publication significantly moderated the strength of ACI-outcome correlations. Conclusions: Competence and integrity are significantly associated with clinical outcome, with a magnitude comparable to wider common factors. Further research is required to study these process-outcome associations with greater precision in routine-care settings and to understand the role of moderating variables.en_US
rioxxterms.funder.project94a427429a5bcfef7dd04c33360d80cden_US


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