Background Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results The results revealed that the therapeutic bond did not predict treatment outcome (r=−0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=−0.42; P=.004 and r=−0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=−0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.

Chronic worry and generalized anxiety disorder (GAD) symptoms are associated with infrequent savoring, and high dampening, of positive emotions. The goal of the present study was to investigate the indirect role of GAD-relevant processes, including intolerance of uncertainty (IU), fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation, in the relationship between GAD symptom severity and the tendency to engage in dampening and not savor positive emotions. Community participants ( N = 233) completed questionnaires online. In separate models, IU, fear of negative emotional contrasts, and negative beliefs about positive emotion and its regulation fully mediated the relationships between GAD symptom severity and greater dampening and lower savoring. However, controlling for depression, only IU remained a significant mediator. A post hoc latent analysis of the mediators provided support for an underlying construct that may reflect intolerance of uncomfortable states. Intolerance of uncomfortable states was found to significantly mediate the relationship between GAD symptoms and greater dampening and lower savoring. Difficulty withstanding uncertainty may be particularly relevant in understanding why people with elevated GAD symptoms engage in efforts to avoid experiencing positive emotions. Further, the findings suggest that there may be a common factor underlying a variety of GAD-associated constructs reflecting a broad intolerance of uncomfortable inner states. Theoretical and clinical implications are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s41811-022-00145-x.

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Le trouble d’anxiété généralisée (TAG) est le seul trouble anxieux sans critères diagnostiques comportementaux. Dans leur revue des critères diagnostiques du TAG pour le Diagnostic and Statistical Manual of Mental Disorders (5e éd.; DSM–5; American Psychiatric Association, 2013), Andrews et ses collègues (2010) ont suggéré l’ajout de quatre comportements sécurisants, lesquels n’ont toutefois pas été retenus. À partir de ces recommandations et de notre expérience en pratique clinique, nous avons développé un questionnaire autorapporté de 18 items (le Questionnaire sur les comportements sécurisants du trouble d’anxiété généralisée, QCS-TAG; Hebert & Dugas, 2019) évaluant la présence de comportements sécurisants cliniquement liés au TAG. L’objectif de l’étude est de vérifier la pertinence des 18 items de la version initiale (non validée) et d’examiner les qualités psychométriques du nouvel outil comprenant uniquement les items retenus. Soixante (60) participants ayant un TAG primaire ont été évalués avant et après avoir reçu un traitement cognitivo-comportemental de 12 rencontres, à raison d’une par semaine. La version abrégée de 10 items a montré une bonne cohérence interne (α = 0,78) et une fidélité test-retest acceptable jusqu’à un intervalle de 12 semaines durant une période de liste d’attente, r = 0,64, p < 0,001. Aussi, la validité convergente, divergente et prédictive a été appuyée. Ce questionnaire s’avère donc un outil pertinent pour un contexte clinique et de recherche. Des considérations théoriques pour l’étiologie et la phénoménologie du TAG sont présentées.

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