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McEvoy PM, Johnson AR, Kazantzis N, Egan SJ. Predictors of homework engagement in group CBT for social anxiety: client beliefs about homework, its consequences, group cohesion, and working alliance. Psychother Res 2024; 34:68-80. [PMID: 38109521 DOI: 10.1080/10503307.2023.2286993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) is effective, but little data exist on generic relational components of the therapeutic process, such as group cohesion and therapy alliance, and central CBT-specific components such as homework engagement, beliefs, and perceived consequences. The aim of this study was to investigate the relationships between homework, group cohesion, and working alliance during group CBT for social anxiety disorder. METHOD Participants (N = 105) with SAD engaged in 12 sessions of group CBT. Measures of homework, working alliance, and group cohesion were completed at multiple points throughout treatment. Random-intercept cross-lagged panel models were used to evaluate the prospective relationships between measures. RESULTS Prospective relationships between the homework outcomes did not vary throughout the treatment period, with the only significant relationships seen between the random intercepts ("trait" levels). Homework beliefs were a significant negative predictor of future group cohesion, but only in mid- to late-treatment. Homework consequences and working alliance were significantly and positively predictive of each other throughout therapy. CONCLUSION Early homework engagement is associated with higher engagement throughout therapy. Working alliance and homework engagement are important to bolster early in group CBT.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000579493..
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Affiliation(s)
- Peter M McEvoy
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- North Metropolitan Health Service, Centre for Clinical Interventions, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Department of Computer Science, Aalto University, Helsinki, Finland
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | - Sarah J Egan
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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McEvoy PM, Bendlin M, Johnson AR, Kazantzis N, Campbell BNC, Bank SR, Egan SJ. The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder. Psychother Res 2024; 34:54-67. [PMID: 36630684 DOI: 10.1080/10503307.2022.2161966] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.
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Affiliation(s)
- Peter M McEvoy
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - Martyna Bendlin
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | | | | | - Sarah J Egan
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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Luong HK, Roberge P, Provencher MD, Kilby CJ, Drummond SPA, Norton PJ. Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders. Clin Psychol Psychother 2022; 29:1742-1754. [PMID: 35383418 DOI: 10.1002/cpp.2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022]
Abstract
The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.
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Affiliation(s)
- Hoang K Luong
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Christopher J Kilby
- School of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Victoria, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Peter J Norton
- School of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Victoria, Australia
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Luong HK, Drummond SPA, Norton PJ. Can you see what I see? A comparison of client and observer perspectives of the alliance and group cohesion in CBT. Cogn Behav Ther 2021; 51:100-113. [PMID: 33843466 DOI: 10.1080/16506073.2021.1898463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Both therapeutic alliance and group cohesion have been identified as "demonstrably effective" relationship elements in therapy. However, the overwhelming majority of process-outcome research has relied on clients as raters of the therapeutic relationship. A lack of convergence between client, therapist, and observer perspectives has raised questions regarding how best to measure relationships in therapy. Interest in observational measures has grown, as they may offer more objective and reliable measurements of process. This study compared the predictive validity of client and observer ratings of the alliance (Agreement and Bond) and group cohesion in the context of group cognitive behaviour therapy (CBT) for anxiety disorders. Results showed that client and observer ratings of process were not significantly correlated, and regarding the alliance, only client-rated Agreement predicted client-rated treatment gains. In contrast, both client and observer-ratings of group cohesion were found to uniquely contribute to treatment outcomes. If replicated, the findings from the present study suggest that (1) while client ratings of alliance consistently predict client-rated outcomes, the predictive validity of observer measures has yet to be established, and (2) both clients and observers provide meaningful and distinct information about group cohesion in therapy.
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Affiliation(s)
- Hoang K Luong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peter J Norton
- School of Psychology, Counselling, and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Victoria, 3123, Australia
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Kivity Y, Strauss AY, Elizur J, Weiss M, Cohen L, Huppert JD. The alliance mediates outcome in cognitive-behavioral therapy for social anxiety disorder, but not in attention bias modification. Psychother Res 2020; 31:589-603. [PMID: 33112720 DOI: 10.1080/10503307.2020.1836423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: The aim of the current study was to examine changes in the therapeutic alliance and its role as a mediator of treatment outcome in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). Method: Patients were randomized to 16-20 sessions of CBT (n = 33) or 8 sessions of ABM (n = 17). Patient-rated alliance and self-reported social anxiety were measured weekly and evaluator-rated social anxiety was measured monthly. Results: Early alliance predicted greater subsequent anxiety reduction in CBT but not in ABM. The alliance increased and weekly improvements in alliance predicted weekly contemporaneous and subsequent decreases in anxiety only in CBT. Decreases in anxiety did not predict subsequent improvements in alliance. Both treatments were effective in reducing anxiety, but treatment effects were mediated by stronger early alliance and stronger cross-lagged effects of alliance on outcome in CBT compared to ABM. Conclusions: The results highlight the importance of the alliance in CBT for SAD. Further studies should examine the role of alliance alongside additional mediators to better understand differential mechanisms in CBT and ABM.
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Affiliation(s)
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Jonathan Elizur
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Lior Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Israel
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Change Processes in Cognitive Therapy for Social Anxiety Disorder Delivered in Routine Clinical Practice. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2. [PMID: 34870201 PMCID: PMC7612064 DOI: 10.32872/cpe.v2i2.2947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings. Method To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cognitive Therapy for SAD (total N = 271). Three process variables (self-focused attention, negative social cognitions, and depressed mood) were examined using multilevel structural equation models. Results Significant indirect effects were observed for all three variables in both samples, with negative social cognitions showing the strongest percent mediation effect. ‘Reversed’ relationships, where social anxiety predicted subsequent process variable scores, were also supported. Conclusion The findings suggest the processes of change in this treatment may be similar between research trials and routine care. The three process variables examined showed significant indirect effects on subsequent social anxiety. There was evidence of a bidirectional relationship between process and outcome. Results are consistent with the theoretical model underpinning the treatment. The change processes of this treatment in routine practice may be similar to those found in research trials.
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Biagiarelli M, Curto M, Listanti G, Andraos MP, Pazzelli F, Aprile V, Pelaccia S, Mantovani B, Caccia F, Carpentieri R, Trabucchi G, Tambelli R, Girardi P, Ferracuti S, Baldessarini RJ, Sarlatto C. Efficacy of the Cooperative Assessment Method (COOPAS) to Improve the Psychiatric Care of Help-Seeking Adolescents. CLINICAL NEUROPSYCHIATRY 2019; 16:189-196. [PMID: 34908955 PMCID: PMC8650201 DOI: 10.36131/clinicalnpsych2019050601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Effective treatment of adolescents with psychopathological disorders is essential to reduce later morbidity and disability. To evaluate the clinical value of a new adolescent Cooperative Assessment scheme (COOPAS) as indicated by establishing therapeutic alliance, improving symptoms, and particularly by reducing dropouts. Method Consecutive help-seeking adolescents (N=136) were recruited, evaluated with an 8-week COOPAS protocol and followed for 6 months to document dropouts during treatment. Clinical rating scales [Hamilton Depression and Anxiety scales (HAM-D, HAM-A), Global Functioning Role and Social Scales (GF-RS, GF-SS), Structured Interview for Prodromal Symptoms (SIPS), Clinical Global Impression (CGI), Working Alliance Inventory-Therapist version (WAI-T), Therapist Response Questionnaire (TRQ), Psychotherapy Relationship Questionnaire (PRQ)] were administered at intake, 4 weeks later, and at the end of COOPAS evaluation (8 weeks). Results Final HAM-A and HAM-D scores improved by 25%; CGI, GF-SS and GF-RS also improved significantly. Similarly, WAI-T showed significant improvements in all three subscales, and patient-clinician relationships (PRQ) showed decreases in Anxious/Preoccupied and Avoidant/Counterdependent dimensions with increases of the Secure/Engaged measure. After 6 months, dropout rate was 8.82%. Conclusions COOPAS assessment was followed by reduced depressive and anxiety symptoms, good therapeutic alliance, and low dropout in adolescents.
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Affiliation(s)
- Mario Biagiarelli
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.,Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Martina Curto
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Giulia Listanti
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Maria Paola Andraos
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Floriana Pazzelli
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Veronica Aprile
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Simona Pelaccia
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Beatrice Mantovani
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Federica Caccia
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Renato Carpentieri
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Guido Trabucchi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Paolo Girardi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, McLean Hospital, Harvard Medical School
| | - Cinzia Sarlatto
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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González OF, Pérez JC, Krause M. The relation between the therapeutic alliance and communicative intentions in therapeutic interaction during the initial phase of adolescent therapy. ACTA ACUST UNITED AC 2019; 22:356. [PMID: 32913796 PMCID: PMC7451329 DOI: 10.4081/ripppo.2019.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/26/2019] [Indexed: 11/23/2022]
Abstract
This study aims to examine the connection between the therapeutic alliance (TA) - from both the patient's and the therapist's perspectives - and communicative intentions during the initial phase of adolescent psychotherapy. The sample comprised the first three sessions of 19 adolescents' individual psychotherapeutic processes. Fifty therapeutic conversation segments were analyzed, representing 2043 adolescent and 3208 therapist speaking turns. The variables studied were Therapeutic Alliance, measured with the Working Alliance Inventory and Communicative Intentions (Exploring, Attuning and Resignifying), assessed by the Therapeutic Activity Coding System. A multilevel analysis was performed (HLM software). The Tasks dimension of the TA perceived by the adolescents increases the likelihood that their discourse will focus on providing and requesting information (Exploring), while also reducing the probability that they will seek to work together with the therapist to achieve mutual understanding (Attuning). The therapists' discourse shows that a strong TA in the Bonds dimension makes it more probable for their utterances to focus on the construction of new meanings (Resignifying). Also, a stronger TA in the Goals dimension makes it more likely for their discourse to be directed toward seeking Attunement with the adolescent.
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Affiliation(s)
- Olga Fernández González
- Department of Psychiatric and Mental Health, University of Chile, Santiago.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago
| | - J Carola Pérez
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago.,Attachment and Emotional Regulation Center, Universidad del Desarrollo, Santiago
| | - Mariane Krause
- Attachment and Emotional Regulation Center, Universidad del Desarrollo, Santiago.,Psychology School, Catholic University of Chile, Santiago, Chile
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Santoft F, Salomonsson S, Hesser H, Lindsäter E, Ljótsson B, Lekander M, Kecklund G, Öst LG, Hedman-Lagerlöf E. Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout. Behav Ther 2019; 50:475-488. [PMID: 31030867 DOI: 10.1016/j.beth.2018.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017, 95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.
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10
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van Rijn B, Wild C. Comparison of Transactional Analysis Group and Individual Psychotherapy in the Treatment of Depression and Anxiety. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0362153715615115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Juicy Conceptualizations: Increasing Alliance Through Attending to Client Metaphoric Language. Behav Cogn Psychother 2017; 45:577-589. [PMID: 28511729 DOI: 10.1017/s1352465817000339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increasing interest in the use of metaphor in cognitive behaviour therapy. Experts advocate bringing client metaphors into case conceptualizations, but there is little empirical research to support this. AIMS This study evaluated the effect of training 12 therapists to attend to client metaphors and bring them into case conceptualizations. METHOD Pre- and post-training role-played therapy sessions were conducted and video-recorded. Alliance was rated by role play 'clients' and an external expert rated the quality of the sessions and of the shared conceptualizations. RESULTS There were significant increases in some ratings of alliance, based on role play 'client' ratings and external ratings of role plays of therapy sessions before and after training. The greater the difference between therapist and 'client' on a measure of preference for producing metaphor, the lower the rating of the session by the 'client' on the Bond factor score of an alliance measure, the Working Alliance Inventory. This result suggests that working metaphorically may be most effective when the therapist and client have a similar degree of preference for speaking metaphorically. CONCLUSION This study provides preliminary support for the idea that attending to client metaphors during conceptualization can be beneficial for alliance.
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12
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Johnson SU, Hoffart A. Metacognitive Therapy for Comorbid Anxiety Disorders: A Case Study. Front Psychol 2016; 7:1515. [PMID: 27746757 PMCID: PMC5043054 DOI: 10.3389/fpsyg.2016.01515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/20/2016] [Indexed: 11/13/2022] Open
Abstract
We aimed to systematically evaluate a generic model of metacognitive therapy (MCT) with a highly comorbid anxiety disorder patient, that had been treated with diagnosis-specific cognitive-behavioral therapy (CBT) without significant effect. Traditionally, CBT has progressed within a disorder-specific approach, however, it has been suggested that this could be less optimal with highly comorbid patients. To address comorbidity, transdiagnostic treatment models have been emerging. This case study used an AB-design with repeated assessments during each therapy session and a 1-year follow-up assessment to evaluate the effectiveness of MCT. Following 8 sessions of MCT, significant decrease in anxiety and depression symptoms, as well as loss of diagnostic status was observed. Outcomes were preserved at 12 months follow up. The generic model of MCT seems promising as an approach to highly comorbid mixed anxiety depression patients. Further testing using more powered methodologies are needed.
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Affiliation(s)
- Sverre U Johnson
- Clinical Psychology, University of OsloOslo, Norway; Modum Bad Psychiatric CenterVikersund, Norway
| | - Asle Hoffart
- Clinical Psychology, University of OsloOslo, Norway; Modum Bad Psychiatric CenterVikersund, Norway
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13
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Raykos BC, McEvoy PM, Erceg-Hurn D, Byrne SM, Fursland A, Nathan P. Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: Probably necessary but definitely insufficient. Behav Res Ther 2014; 57:65-71. [DOI: 10.1016/j.brat.2014.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 04/09/2014] [Accepted: 04/16/2014] [Indexed: 01/13/2023]
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The role of the therapeutic relationship in cognitive behaviour therapy for chronic fatigue syndrome. Behav Res Ther 2013; 51:368-76. [PMID: 23639303 DOI: 10.1016/j.brat.2013.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/15/2012] [Accepted: 02/06/2013] [Indexed: 11/24/2022]
Abstract
Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) can reduce fatigue and impairment. Recently, it was found that changes in fatigue-perpetuating factors, i.e. focusing on symptoms, control over fatigue, perceived activity and physical functioning, are associated with and explain up to half of the variance in fatigue during CBT for CFS. The therapy relationship, e.g. outcome expectations and working alliance, may also contribute to treatment outcome. We aimed to examine the role of the therapy relationship in CBT and determine whether it exerts its effect independently of changes in fatigue-perpetuating factors. We used a cohort of 217 CFS patients in which the pattern of change in fatigue-perpetuating factors was examined previously. Fatigue, therapy relationship and fatigue-perpetuating factors were measured at the start of therapy, three times during CBT and at the end of therapy. Baseline outcome expectations and agreement about the content of therapy predicted post therapy fatigue. A large part of the variance in post-treatment fatigue (25%) was jointly explained by outcome expectations, working alliance and changes in fatigue-perpetuating factors. From this, we conclude that positive outcome expectations and task agreement seem to facilitate changes in fatigue-perpetuating factors during CBT for CFS. It is therefore important to establish a positive therapy relationship early in therapy.
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15
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Bergman Nordgren L, Carlbring P, Linna E, Andersson G. Role of the working alliance on treatment outcome in tailored internet-based cognitive behavioural therapy for anxiety disorders: randomized controlled pilot trial. JMIR Res Protoc 2013; 2:e4. [PMID: 23612437 PMCID: PMC3628159 DOI: 10.2196/resprot.2292] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/15/2012] [Accepted: 01/08/2013] [Indexed: 12/02/2022] Open
Abstract
Background Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly. Objectives The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders. Methods Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27). Results Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27). Conclusions These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT.
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Affiliation(s)
- Lise Bergman Nordgren
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
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