Enhancing Psychotherapy Research: The Critical Need for Detailed Reporting of Intervention Protocols

Dear Editor,

Psychotherapy research has seen a shift in recent years, moving away from anecdotal evidence toward more rigorous clinical trials. However, the results of many trials remain unutilized due to insufficient reporting of intervention details. This under-reporting presents a significant challenge for clinicians who require access to evidence-based techniques. Unfortunately, a lack of published intervention protocols or adaptations in psychotherapy trials renders much of the research unusable. In psychotherapy, a wide gulf exists between clinicians and researchers, ¹ as clinicians with direct client contact often do not participate in research. Researchers who do not have significant clinical, direct client or intervention delivery experience conduct interventions in psychotherapy research in highly controlled environments. ² Clinicians who want to provide Evidence-based Psychotherapy (EBP) require access to tested intervention protocols. A recent review, ³ of 137 interventions from 133 trials involving non-pharmacological treatments revealed that just 39% of the interventions were sufficiently detailed in the primary publication or supplementary materials such as references, appendices, supplementary information, or online sources. The same study found that key stakeholders could access 51% of the trials with adequate treatment protocols by directly contacting the authors of the articles. The review also identified “intervention materials” as the most commonly missing element. The primary reasons for this omission included concerns over copyright or intellectual property, lack of access to the materials or detailed intervention information, or insufficient awareness of the significance of including these details in the reporting.

Particularly in psychotherapy research, there is a significant lack of reporting on information related to treatment and intervention. Incomplete descriptions of interventions, restricted access, lack of standardization, variability in therapist training, and contextual differences render the intervention uninterpretable and unusable by clinicians, patients, and researchers. This under-reporting also significantly hampers the ability to replicate treatments, which is crucial for validating the effectiveness of a therapy. ⁴

To address this problem in reporting trials, the CONSORT (Consolidated Standards of Reporting Trials), ⁵ developed an extension of the 22-item CONSORT checklist to include items for non-pharmacological trials like psychotherapy trials. These trials usually involve complex interventions with several components, making reporting qualitative and quantitative data crucial, as indicated in the CONSORT checklist. Qualitative data should include details on session content, delivery format (individual or group), supervision, participant interactions, and tools used. For instance, in a cognitive-behavioural therapy trial, the checklist could guide the reporting of the specific cognitive restructuring techniques used, the frequency and duration of exposure sessions, and the measures used to assess changes in cognitive distortions. Quantitative data should cover the number, timing, and duration of sessions, the duration of each main component, and the overall length of the intervention. ⁶

The TIDieR (Template for Intervention Description and Replication) checklist, ⁷ has 11 items not included in the CONSORT 2010 or SPIRIT (Standardized Protocol Items: Recommendations for Intervention Trials) checklist, ⁸ which helps researchers present specific information about the intervention like modifications, the rationale for modifications, tailoring of the intervention and the number of times the invention was delivered, over what time period including the number of sessions, their duration, and intensity. For psychologists and psychotherapists, a detailed understanding of the nuances of tailoring interventions for clients with co-morbidities and adverse events, along with providing a rationale for why an intervention was adapted or personalized for a particular participant, is significant data and is crucial in delivering safe and empirically validated interventions.

Understanding the population is crucial information, as psychotherapy trials tend to use the accessible population. ⁹ Therefore, understanding the features of the population is critical to understanding the impact of cultural, socio-economic, co-morbidities, and psychosocial stressors on the effectiveness of the intervention. ² This information in a psychotherapy intervention is crucial data for the usability and replicability of the empirically validated intervention.

Journals can also mandate checklist submissions and videos explaining findings, integrate checklists into peer review, offer training and resources on using standardized checklists, and highlight replicability to clinical trial authors to allow for the usability and implementation of the intervention beyond the trial into clinical practice. ¹⁰