Therapist adherence in cognitive-behavioral therapy for binge-eating disorder

Cognitive-behavioral therapy (CBT) has been established as the treatment of choice for binge-eating disorder (BED) which is characterized by recurrent binge eating episodes; however, only little is known about the impact of the psychotherapeutic process on treatment outcome. Because studies concerning the process aspect of therapist adherence found differences between patients from one therapist as well as differences between therapists, the impact of patient and therapist characteristics on therapist adherence was investigated. In a prospective multicenter randomized controlled trial comparing CBT to Internet-based guided self-help (INTERBED), the therapist adherence to CBT was determined by independent raters. Patient and therapist characteristics were obtained via interview and self-report questionnaires. Sociodemographic characteristics, including lower education in patients and female sex in therapists were identified as predictors of higher therapist adherence. Disorder-specific characteristics of patients were not associated with therapist adherence. Therapist characteristics, including less postgraduate therapist training, lower self-rated therapeutic competence and higher expectations as well as higher emotional well-being of therapists predicted higher therapist adherence. The high level of therapist adherence was mostly independent of patients, while some therapist characteristics were identified as predictors. Adverse impacts on therapist adherence should be investigated further and might be considered in therapeutic training.