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Psychotherapy Adherence of Therapists Treating HIV-Positive Patients With Depressive Symptoms

John C. Markowitz, M.D., Lisa A. Spielman, Ph.D., Polly A. Scarvalone, Ph.D. and Samuel W. Perry, M.D.

Deceased.
Received October 18, 1999; revised December 13, 1999; accepted December 16, 1999. From the Department of Psychiatry, Cornell University Medical College, and the New School–Beth Israel Center for Clinical Training and Research, New York, New York. Address correspondence to Dr. Markowitz, 525 East 68th Street, Room 1322, New York, NY 10021; e-mail: jcmarko{at}mail.med.cornell.edu

Adherence monitoring, a technology to specify research psychotherapies, was used in the NIMH Treatment of Depression Collaborative Research Program (TDCRP). The authors present adherence data from a similar randomized treatment trial of 56 depressed HIV-positive patients, comparing 16-week interventions with cognitive-behavioral therapy, interpersonal psychotherapy, and supportive psychotherapy alone or with imipramine. Therapists were certified in manualized treatments. Blind independent raters rated randomly selected taped sessions on an adaptation of the NIMH scale, yielding adherence scores for interventions and for therapist "facilitative conditions" (FC). All therapists were rated adherent. Interrater reliability was 0.89–0.99. The scale discriminated among the four treatments (P<0.0001), with each scoring highest on its own scale. FC, which might measure therapist competence independent of treatment technique, varied by intervention but did not predict treatment outcome. This study demonstrates the ability to reliably train adherence monitors and therapists able to deliver specified treatments. Its adherence findings provide the first replication of those from the landmark NIMH TDCRP study.

Key Words: AIDS/HIV • Adherence Monitoring

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