Swipe om te navigeren naar een ander artikel
Patients’ outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook, Oxford University Press, New York, 2011a; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press, 2017b) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP vs. SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance [B = 0.037, SE = 0.05, 95% CI (.005, 0.096)]. Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.
Log in om toegang te krijgen
Met onderstaand(e) abonnement(en) heeft u direct toegang:
Ake, C. F. (2005). Rounding after multiple imputation with non-binary categorical covariates. Paper presented at the annual meeting of the SAS Users Group International, Philadelphia, PA.
Barlow, D. H., & Craske, M. G. (2007). Mastery of your anxiety and panic: Workbook (4th edn.). New York, NY: Oxford University Press.
Barlow, D. H., Ellard, K. K., Fairholme, C. P., Farchione, T. J., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011a). Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook. New York: Oxford University Press.
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011b). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.
Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Latin, H., Ellard, K. K., Bullis, J. R.,…, Cassiello-Robbins, C. (2017a). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press. CrossRef
Barlow, D. H., Sauer-Zavala, S., Farchione, T.J., Latin, H., Ellard, K. K., Bullis, J. R.,…, Cassiello-Robbins, C. (2017b). Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press. CrossRef
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, Research and Practice, 16, 252–260. CrossRef
Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorders and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288–298. doi: 10.1037/0022-006X.70.2.288. CrossRefPubMed
Boswell, J. F., Bentley, K. H., & Barlow, D. H. (2015). Motivation facilitation in the unified protocol for transdiagnostic treatment of emotional disorders. In H. Arkowitz, W. Miller & S. Rollnick (Eds.), Motivational interviewing in the treatment of psychological problems (2nd edn., pp. 33–57). New York: Guilford Press.
Boswell, J. F., Constantino, M. J., & Anderson, L. M. (2016). Potential obstacles to treatment success in adults: Client characteristics. In S. Maltzman (Ed.), The Oxford handbook of treatment processes and outcomes in psychology. New York: Oxford University Press. doi: 10.1093/oxfordhb/9780199739134.013.17.
Brown, T. A., & Barlow, D. H. (2014). Anxiety and related disorders interview schedule for DSM-5—Lifetime version. London: Oxford University Press.
Castonguay, L. G., & Beutler, L. E. (Eds.). (2006). Principles of therapeutic change that work. New York, NY: Oxford University Press.
Castonguay, L. G., Constantino, M. J., Boswell, J. F., & Kraus, D. (2010). The therapeutic alliance: Research and theory. In L. Horowitz & S. Strack (Eds.), Handbook of interpersonal psychology: Theory, research, assessment, and therapeutic interventions (pp. 509–518). New York, NY: Wiley.
Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The impact of psychological interventions on medical cost offset: A meta-analytic review. Clinical Psychology: Science and Practice, 6, 204–220.
Connolly Gibbons, M. B., Crits-Christoph, P., de la Cruz, C., Barber, J. P., Siqueland, L., & Gladis, M. (2003). Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychotherapy Research, 13, 59–76. CrossRefPubMed
Constantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of Consulting and Clinical Psychology, 73, 203–211. doi: 10.1037/0022-006X.73.2.203. CrossRefPubMed
Constantino, M. J., Boswell, J. F., Bernecker, S. L., & Castonguay, L. G. (2013). Context-responsive integration as a framework for unified psychotherapy and clinical science: Conceptual and empirical considerations. Journal of Unified Psychotherapy and Clinical Science, 2, 1–20.
Constantino, M. J., Coyne, A. E., Mcvicar, E. L., & Ametrano, R. M. (2016). The relative association between individual difference variables and general psychotherapy outcome expectation in socially anxious individuals. Psychotherapy Research, 11, 1–12.
Constantino, M. J., Glass, C. R., Arnkoff, D. B., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence based responsiveness (2nd edn., pp. 354–376). New York, NY: Oxford University Press. CrossRef
Crits-Christoph, P., Connolly Gibbons, M. B., Hamilton, J., Ring-Kurtz, S., & Gallop, R. (2011). The dependability of alliance assessments: The alliance-outcome correlation is larger than you think. Journal of Consulting and Clinical Psychology, 79, 267–278. doi: 10.1037/a0023668. CrossRefPubMedPubMedCentral
Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version (ADIS-IV-L). New York, NY: Oxford University Press.
Foa, E. B., Yadin, E., & Lichner, T. K. (2008). Obsessive-compulsive disorder: A cognitive-behavioral therapy approach. New York, NY: Oxford University Press.
Frank, J. D. (1961). Persuasion and healing: A comparative study of psychotherapy. Oxford: Johns Hopkins University Press.
Goldstein, A. P. (1962). Patient-therapist expectancies in psychotherapy. Oxford: Pergamon.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: NY: The Guilford Press.
Hollon, S. D., & Beck, A. T. (2013). Cognitive and cognitive-behavioral therapies. In: M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherpay and behavior change (6th edn). Mahwah, NJ: Wiley.
Hope, D. A., Heimberg, R. G., & Turk, C. L. (2006). Managing social anxiety: A cognitive-behavioral therapy approach: Therapist guide. San Antonio, TX: Oxford University Press.
Horvath, A. O., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd edn., pp. 25–69). New York, NY: Oxford University Press. CrossRef
Johansson, P., Høglend, P., & Hersoug, A. (2011). Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy. British Journal of Clinical Psychology, 50, 283–297. PubMed
King, L. A., King, D. W., McArdle, J. J., Saxe, G. N., Doron-Lamarca, S., & Orazen, R. J. (2006). Latent difference score approach to longitudinal trauma research. Journal of Trauma & Stress, 19(6), 771–785.
Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin & Garfield’s handbook of psychotherapy and behavior change (6th edn., pp. 169–218). New York, NY: John Wiley & Sons.
Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051–1055. doi: 10.1037//0022-006X.70.4.1051. CrossRefPubMed
Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work (4th edn.). New York: Oxford University Press.
Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology, 79, 171–181. CrossRefPubMedPubMedCentral
Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1, 207–210. CrossRef
Tsai, M., Ogrodniczuk, J. S., Sochting, I., & Mirmiran, J. (2014). Forecasting success: Patients’ expectations for improvement and their relations to baseline, process and outcome variables in group cognitive-behavioural therapy for depression. Clinical Psychology and Psychotherapy, 21, 97–107. doi: 10.1002/cpp.1831. CrossRefPubMed
Vogel, P. A., Hansen, B., Stiles, T. C., & Götestam, K. (2006). Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. Journal of Behavior Therapy and Experimental Psychiatry, 37, 247–255. doi: 10.1016/j.jbtep.2005.12.001. CrossRefPubMed
Webb, C. A., Kertz, S. J., Bigda-Peyton, J. S., & Björgvinsson, T. (2013). The role of pretreatment outcome expectancies and cognitive–behavioral skills in symptom improvement in an acute psychiatric setting. Journal of Affective Disorders, 149, 375–382. doi: 10.1016/j.jad.2013.02.016. CrossRefPubMedPubMedCentral
Zinbarg, R., Craske, M., & Barlow, D. H. (2006). Therapist’s guide for the mastery of your anxiety and worry program. New York, NY: Oxford University Press. CrossRef
- Expectancies, Working Alliance, and Outcome in Transdiagnostic and Single Diagnosis Treatment for Anxiety Disorders: An Investigation of Mediation
James F. Boswell
Kate H. Bentley
Todd J. Farchione
David H. Barlow
- Springer US