Date of Award
8-11-2020
Degree Name
Doctor of Philosophy (PhD)
Degree Type
Dissertation
Abstract
Introduction: Individuals with eating disorders often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible clinician training in these treatments. In-person workshops are the standard method of therapist training; this method is expensive, time consuming, and requires an expert trainer. More scalable training and treatment fidelity assessment tools, such as online training and telephone-based simulation assessment of therapist treatment fidelity, are needed and could lead to greater dissemination of evidence-based treatment. The current study developed a novel IPT online training platform and telephone-based simulation assessment of therapist fidelity and examined: 1) whether online training is non-inferior to in-person training with expert follow-up consultation in terms of training outcomes (i.e., IPT fidelity, patient symptom change, IPT knowledge, acceptance of IPT, acceptance of evidence-based treatments); 2) whether fidelity ratings of the telephone-based simulation and of audio-recorded therapy sessions of IPT delivery are correlated; and 3) whether treatment fidelity (assessed via ratings from the telephone-based simulation and audio-recorded therapy sessions of IPT delivery) following training predicted improved patient outcomes. Methods: Participants were therapists (N = 60) and the student patients (N = 42) they enrolled at 38 college counseling centers across the U.S. At baseline, therapists completed assessments, which included questionnaires and a telephone-based simulation, and collected data from a student patient who presented to treatment for eating disorder symptoms. Therapists then took part in an IPT online training program. After training, therapists again completed assessments (questionnaires and a second telephone-based simulation), collected data from another student patient who presented to treatment for eating disorder symptoms, and completed a final round of questionnaires and a telephone-based simulation. Results: Findings demonstrated that: 1) IPT online training was non-inferior to in-person training on all outcomes, and may even be superior to in-person training in terms of improving IPT competence; 2) post-training telephone-based simulation fidelity did not significantly correlate with fidelity ratings from audio-recorded therapy sessions of IPT delivery, and 3) following IPT training, IPT fidelity predicted improvements in patient symptoms on some outcomes; specifically, IPT adherence from the telephone-based simulation predicted improvements in depression symptoms, and IPT adherence from audio-recorded therapy sessions of IPT delivery predicted improvements in objective binge eating at a marginally significant level. Discussion: Results provide support for the non-inferiority of IPT online training compared to in-person training, and some support that IPT treatment fidelity is associated with better patient outcomes. Although IPT fidelity ratings from the telephone-based simulation were not correlated with the ratings from the audio-recorded therapy sessions of IPT delivery, the finding that IPT adherence, assessed via telephone-based simulation, predicted improvements in patient depression symptoms provides support for the utility of telephone-based simulations. Findings provide support for the use and dissemination of IPT online training and telephone-based simulations, which ultimately could increase access to evidence-based eating disorder treatment and improve patient care. Study strengths, limitations, and future directions are discussed.
Language
English (en)
Chair and Committee
Denise Wilfley
Recommended Citation
Karam, Anna, "The Dissemination and Implementation of an Evidence-Based Eating Disorder Treatment: Online Training for Clinician Delivery of Interpersonal Psychotherapy" (2020). Arts & Sciences Electronic Theses and Dissertations. 3258.
https://openscholarship.wustl.edu/art_sci_etds/3258