Alliance and Outcome in Cognitive-Behavioral Therapy for Adolescent Depression

Shirk, Stephen R.; Gudmundsen, Gretchen; Kaplinski, Heather Crisp; McMakin, Dana L.

doi:10.1080/15374410802148061

Cited by 89 publications

(78 citation statements)

References 38 publications

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“…Other measures, such as the Therapeutic Alliance Scales for Children-Revised, 35 the Client Evaluation of Services Questionnaire, and the Computer System Usability Questionnaire, were used to assess app and portal usability. The average time that patients took to complete skills coach entries was also calculated.…”

Section: Initial Evaluationmentioning

confidence: 99%

The SmartCAT: An m-Health Platform for Ecological Momentary Intervention in Child Anxiety Treatment

Pramana

Parmanto

Kendall

et al. 2014

Telemedicine and e-Health

151

143

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Introduction: Cognitive behavioral therapy (CBT) for child anxiety, although efficacious, typically requires 16-20 weekly sessions with a therapist. Brief CBT (BCBT; eight sessions) for child anxiety is promising but may have less favorable outcomes owing to reduced session time. Mobile health (m-health) has the potential to improve BCBT efficacy by delivering ecological momentary intervention to engage youth in learning and practicing CBT skills in their everyday lives (in vivo). Materials and Methods: We developed an m-health platform entitled SmartCAT (Smartphone-enhanced Child Anxiety Treatment). SmartCAT consists of (1) a smartphone application (app) that cues youth to use the CBT skills taught in sessions, (2) an online portal that allows therapists to monitor skill use, to send cues and treatment-related materials, to engage youth in real-time via secure messages, and to manage rewards, and (3) a communication protocol that allows real-time bidirectional exchange between the app and the portal. A pilot study with nine youth (9-14 years old) examined the platform's feasibility as an adjunct to BCBT. Results: SmartCAT was found to be capable of supporting BCBT for child anxiety and received positive feedback from both therapists and youth patients. Patients rated the app as highly usable (mean = 1.7 on a 1-7 scale, with 1 = ''easy''). Patients completed 5.36 skills coach entries per session (standard deviation = 1.95) and took an average of 3.14 min (standard deviation = 0.98 min) to complete the entries. Conclusions: A smartphone app is feasible within CBT for child anxiety. Users found SmartCAT both acceptable and easy to use. Integrating an m-health platform within BCBT for anxious children may facilitate involvement in treatment and dissemination of effective procedures.

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Section: Initial Evaluationmentioning

confidence: 99%

The SmartCAT: An m-Health Platform for Ecological Momentary Intervention in Child Anxiety Treatment

Pramana

Parmanto

Kendall

et al. 2014

Telemedicine and e-Health

151

143

View full text Add to dashboard Cite

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“…More recent studies of youth therapeutic alliance have attempted to determine the directionality of these effects by employing prospective methods in which alliance was measured early in psychotherapy and across multiple time points (Chiu, McLeod, Har, & Wood, 2009; Hogue, Dauber, Stambaugh, Cecero, & Liddle, 2006; Kazdin, Whitley, & Marciano, 2006; Shirk, Gudmundsen, Kaplinski, & McMakin, 2008). The majority of these studies indicate that the therapeutic alliance is a moderate predictor of youth symptomatology at subsequent sessions.…”

mentioning

confidence: 99%

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Labouliere

Reyes

Shirk

et al. 2015

Journal of Clinical Child & Adolescent Psychology

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Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth literature; however, past research frequently suffered measurement issues that obscured temporal relationships between alliance and symptomatology by measuring variables later in therapy, thereby precluding examination of important early changes. The current study aimed to explore the directions of effect between alliance and outcome early in therapy with adolescents by examining associations between first- and fourth-session therapeutic alliance and symptomatology. Thirty-four adolescents (~63% female, 38% ethnic/racial minority) participated in a school-based cognitive-behavioral therapy for adolescents with depression. Participants completed the Beck Depression Inventory at baseline and Session 4, and therapeutic alliance was coded from audiotapes of Sessions 1 and 4 by objective coders using the Alliance Observation Coding System. Autoregressive path analyses determined that first-session therapeutic alliance was a strong significant predictor of Session 4 depression symptoms, but pretreatment depression scores were not significantly predictive of subsequent therapeutic alliance. Adding reciprocal effects between alliance and depression scores did not adversely affect model fit, suggesting that reciprocal effects may exist. Early therapeutic alliance with adolescents is critical to fostering early gains in depressive symptomatology. Knowing alliance’s subsequent effect on youth outcomes, clinicians should increase effort to foster a strong relationship in early sessions and additional research should be conducted on the reciprocal effects of therapeutic alliance and treatment outcome in adolescence.

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“…However, various studies have implicated the therapeutic alliance as one potential mediator. It is well established that the therapeutic alliance is a robust outcome predictor in various forms of therapy for depression, including individual CBT [21][22][23]. Additionally, a handful of studies have provided evidence of significant associations between the therapeutic alliance and outcome in various forms of group psychotherapy [24][25][26], and in group CBT specifically [27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Patients’ perceptions of treatment credibility and their relation to the outcome of group CBT for depression

Söchting¹,

Tsai²,

Ogrodniczuk³

2016

Arch Psych Psych

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Alliance and Outcome in Cognitive-Behavioral Therapy for Adolescent Depression

Cited by 89 publications

References 38 publications

The SmartCAT: An m-Health Platform for Ecological Momentary Intervention in Child Anxiety Treatment

The SmartCAT: An m-Health Platform for Ecological Momentary Intervention in Child Anxiety Treatment

Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement

Patients’ perceptions of treatment credibility and their relation to the outcome of group CBT for depression

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