Defense Date


Document Type


Degree Name

Master of Science



First Advisor

Bryce D. McLeod, PhD


The measurement of treatment adherence (i.e., the frequency and thoroughness with which a therapist delivers a treatment as designed) is critical to the field of implementation science, as adherence is often considered an indicator of successful implementation. Most existing instruments of treatment adherence are treatment protocol specific; however, this approach is costly, inefficient, and disallows cross-treatment and cross-study comparisons. Thus, there is a need for adherence instruments that can be used across treatment protocols. It has been suggested that an instrument that captures adherence at the practice element level would meet this need, as it would have utility across protocols that share practice elements. The current study examines the extent to which an observational adherence instrument designed to assess the core common practice elements found in individual cognitive-behavioral therapy (ICBT) for youth anxiety (the Cognitive-Behavioral Therapy Adherence Scale for Youth Anxiety; CBAY-A) can produce scores that can be reliably and validly interpreted across two separate ICBT protocols: Coping Cat (a standard manualized treatment; SMT) and MATCH (a modular manualized treatment; MMT). This study provides initial psychometric data for scores on an SMT subscale (comprised of CBAY-A items found in the SMT protocol) and an MMT subscale (comprised of CBAY-A items found in the MMT protocol) of the CBAY-A. Treatment sessions (n = 359 SMT; n = 243 MMT) from 38 youth participants (n = 22 SMT; n = 16 MMT; M age = 9.84 years, SD = 1.65; 52.6% male, 60.5% Caucasian) in an effectiveness study were independently coded by two coders using the CBAY-A. Inter-rater reliability intraclass correlation coefficients (2,2) for the item scores averaged 0.83 (SD = 0.07) for the SMT group and 0.80 (SD = 0.09) for the MMT group. CBAY-A SMT and CBAY-A MMT subscale scores demonstrated evidence of convergent and discriminant validity via associations with observational instruments of therapist adherence designed specifically for the SMT and MMT protocols, and observational instruments of competence and alliance. Results provide preliminary evidence that the CBAY-A can be effectively used in place of two separate protocol-specific adherence instruments, indicating that it may be a flexible, efficient, and useful tool for capturing adherence to ICBT protocols for youth anxiety in a way that allows for comparisons across treatment protocols and research studies.


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