Skip to main content Accessibility help

Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy

  • Jaime Delgadillo (a1) and Martin Groom (a2)


Background: Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. Aims: This study aimed to evaluate the effects of a programme of three transdiagnostic seminars (TDS) for patients with common mental disorders accessing cognitive behavioural therapy (CBT) in primary care. TDS included CBT psychoeducation and role induction. Method: A random sample of patients (n = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared with matched controls (n = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. Results: Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison with usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). Conclusions: Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions.


Corresponding author

Correspondence to Jaime Delgadillo, Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TN, UK. E-mail:


Hide All
Anderson, E. M. and Lambert, M. J. (2001). A survival analysis of clinically significant change in outpatient psychotherapy. Journal of Clinical Psychology, 57, 875888.
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 1731.
Clark, D. M. (2005). A cognitive perspective on social phobia. In Crozier, W. R. and Alden, L. F. (eds), The Essential Handbook of Social Anxiety for Clinicians (pp. 406427). New York, NY: John Wiley and Sons.
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910920.
Cuijpers, P., van Straten, A., Andersson, G. and van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology, 76, 909922.
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A. and Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376385.
Delgadillo, J., McMillan, D., Lucock, M., Leach, C., Ali, S. and Gilbody, S. (2014). Early changes, attrition, and dose-response in low intensity psychological interventions. British Journal of Clinical Psychology, 53, 114130.
Delgadillo, J., Moreea, O. and Lutz, W. (2016). Different people respond differently to therapy: A demonstration using patient profiling and risk stratification. Behaviour Research and Therapy, 79, 1522.
Frank, E., Cassano, G. B., Rucci, P., Thompson, W. K., Kraemer, H. C., Fagiolini, A., Maggi, L., Kupfer, D. J., Shear, M. K., Houck, P. R., Calugi, S., Grochocinski, V. J., Scocco, P., Buttenfield, J. and Forgione, R. N. (2011). Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychological Medicine, 41, 151162.
Garrison, J. E. (1978). Written vs. verbal preparation of patients for group psychotherapy. Psychotherapy: Theory, Research and Practice, 15, 130134.
Gloaguen, V., Cottraux, J., Cucherat, M. and Blackburn, I. M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 5972.
Hammond, G., Croudace, T., Radhakrishnan, M., Lafortune, L., Watson, A., McMillan-Shields, F. and Jones, P. B. (2012). Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: an observational study using propensity methods. PLoS ONE, 7, e42916.
Hansen, N. B., Lambert, M. J. and Forman, E. M. (2002). The psychotherapy dose response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9, 329343.
Harvey, A., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. Oxford, UK: Oxford University Press.
Heitler, J. B. (1973). Preparation of lower-class patients for expressive group psychotherapy. Journal of Consulting and Clinical Psychology, 41, 251260.
Heitler, J. B. (1976). Preparatory techniques in initiating expressive psychotherapy with lower-class, unsophisticated patients. Psychological Bulletin, 83, 339352.
Hofmann, S. G. and Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621632.
Howard, K. I, Kopta, S. M., Krause, M. S. and Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41, 159164.
IAPT National Programme Team (2011). The IAPT Data Handbook: Guidance on Recording and Monitoring Outcomes to Support Local Evidence-Based Practice (2nd edn). London: National IAPT Programme Team.
Jacobs, D., Charles, E., Jacobs, T., Weinstein, H. and Mann, D. (1972). Preparation for treatment of the disadvantaged patient: Effects on disposition and outcome. American Journal of Orthopsychiatry, 42, 666674.
Jacobson, N. S. and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Kozak, M. J. and Foa, E. B. (1997). Mastery of Obsessive Compulsive Disorder: a Cognitive Behavioural Approach Therapist Guide. New York, NY: Oxford University Press.
Kraemer, H. C. and Kupfer, D. J. (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry, 59, 990996.
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O. and Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317325.
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L. and Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288301.
Lutz, W., Leon, S. C., Martinovich, Z., Lyons, J. S. and Stiles, W. B. (2007). Therapist effects in outpatient psychotherapy: A three level growth curve approach. Journal of Counseling Psychology, 54, 3239.
Lutz, W., Lowry, J., Kopta, S. M., Einstein, D. A. and Howard, K. I. (2001). Prediction of dose–response relations based on patient characteristics. Journal of Clinical Psychology, 57, 889900.
Macaskill, N. D. (1989). Educating clients about rational-emotive therapy. In Dryden, W. and Trower, E. (eds), Cognitive Psychotherapy: Stasis and Change (pp. 8798). New York: Springer.
Macaskill, N. D. and Macaskill, A. (1983). Preparing patients for psychotherapy. British Journal of Clinical and Social Psychiatry, 2, 8084.
Maling, M. S., Gurtman, M. B. and Howard, K. I. (1995). The response of interpersonal problems to varying doses of psychotherapy. Psychotherapy Research, 5, 6375.
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: Strategies for Guided Action. New York, NY: Norton.
Mundt, J. C., Marks, I. M., Shear, M. K. and Greist, J. H. (2002). The work and social adjustment scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461464.
National Institute for Health and Care Excellence (2007). Anxiety (amended): Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. London: NICE.
National Institute for Health and Care Excellence (2010). Depression: the Treatment and Management of Depression in Adults (updated edn). London: The British Psychological Society and The Royal College of Psychiatrists.
National Institute for Health and Care Excellence (2011). Common Mental Health Disorders: Identification and Pathways to Care. London: National Collaborating Centre for Mental Health.
Richards, D. A. and Borglin, G. (2011). Implementation of psychological therapies for anxiety and depression in routine practice: two year prospective cohort study. Journal of Affective Disorders, 133, 5160.
Roth, A. D. and Pilling, S. (2008). Using an evidence-based methodology to identify the competencies required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36, 129147.
Schafer, J. L. and Olsden, M. K. (1998). Multiple imputation for multivariate missing-data problems: A data analyst's perspective. Multivariate Behavioral Research, 33, 545571.
Sheeran, P., Aubrey, R. and Kellett, S. (2007). Increasing attendance for psychotherapy: implementation intentions and the self-regulation of attendance-related negative affect. Journal of Consulting and Clinical Psychology, 75, 853863.
Shimokawa, K., Lambert, M. J. and Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298311.
Smith, J. and Todd, P. (2005). Does matching overcome LaLonde's critique of non-experimental estimators? Journal of Econometrics, 125, 305353.
Spitzer, R., Kroenke, K., Williams, J. B. W. and Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 66, 10921097.
Stark, M. J. and Kane, B. J. (1985). General and specific psychotherapy role induction with substance-abusing clients. International Journal of the Addictions, 20, 11351141.
Stiles, W. B., Barkham, M., Twigg, E., Mellor-Clark, J. and Cooper, M. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine, 36, 555566.
Stiles, W. B., Barkham, M., Mellor-Clark, J. and Connell, J. (2008). Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample. Psychological Medicine, 38, 677688.
Swift, J. K. and Callahan, J. L. (2011). Decreasing treatment dropout by addressing expectations for treatment length. Psychotherapy Research, 21, 193200.
Swift, J. K. and Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547559.
Vogel, D. L., Wester, S. R. and Larson, L. M. (2007). Avoidance of counseling: Psychological factors that inhibit seeking help. Journal of Counseling and Development, 85, 410422.
Walitzer, K. S., Dermen, K. H. and Connors, G. J. (1999). Strategies for preparing clients for treatment. Behavior Modification, 23, 129151.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy

  • Jaime Delgadillo (a1) and Martin Groom (a2)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *