The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Krupnick, J.L.; Sotsky, Stuart M.; Simmens, Samuel J.; Moyer, Janet; Elkin, Irene; Watkins, John B.; Pilkonis, Paul A.

doi:10.1037/0022-006x.64.3.532

Cited by 672 publications

(439 citation statements)

References 25 publications

(32 reference statements)

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“…It has been shown that the therapeutic alliance is strongly and positively related to outcome in drug treatment, just as it is in psychotherapy [144]. One reason may be that the drug condition usually involves weekly contact combined with supportive psychotherapy [145], a higher level of drug treatment than is usually delivered in the typical outpatient setting.…”

Section: Belief No 4: Antidepressants Are More Effective Than Psychomentioning

confidence: 99%

Raising Questions about Antidepressants

Antonuccio

Danton

DeNelsky

et al. 1999

Psychother Psychosom

104

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Antidepressant medication has apparently become the most popular treatment for depression in the USA. Several beliefs about the efficacy of antidepressant medications prevail among mental health professionals and the public. This paper explores relevant research data and raises questions about these beliefs. Many of the common beliefs about these medications are not adequately supported by scientific data. The following issues are raised: (1) industry-funded research studies which result in negative findings sometimes do not get published; (2) placebo washout procedures may bias results in some studies; (3) there are serious questions about the integrity of the double-blind procedure; (4) the ‘true’ antidepressant drug effect in adults appears to be relatively small; (5) there is minimal evidence of antidepressant efficacy in children; (6) side effects are fairly common even with the newer antidepressants; (7) combining medications raises the risk for more serious complications; (8) all antidepressants can cause withdrawal symptoms; (9) genetic influences on unipolar depression appear to be weaker than environmental influences; (10) biochemical theories of depression are as yet unproven; (11) biological markers specific for depression have been elusive; (12) dosage and plasma levels of antidepressants have been minimally related to treatment outcome; (13) preliminary evidence suggests that patients who improve with cognitive-behavioral psychotherapy show similar biological changes as those who respond to medication, and (14) the evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.

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Section: Belief No 4: Antidepressants Are More Effective Than Psychomentioning

confidence: 99%

Raising Questions about Antidepressants

Antonuccio

Danton

DeNelsky

et al. 1999

Psychother Psychosom

104

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“…A positive early therapeutic alliance has been shown repeatedly to be a good predictor of outcome in psychotherapy (Horvath, 2005;Horvath & Symonds, 1991). Indeed, in an analysis of the role that the therapeutic alliance played in the brief treatments for depression, the TDCRP and Krupnick et al (1996) found that the quality of the therapeutic alliance was a better predictor of outcomes than any of the specifi c techniques and tactics in the treatment manuals. Hence, the quality of the treatment relationship established early in treatment is probably the key factor contributing to the therapeutic gain in the brief outpatient treatment of serious depression.…”

Section: Childhood Traumamentioning

confidence: 99%

The impact of personality and personality disorders on the treatment of depression

Gabbard

Simonsen

2007

Personality & Mental Health

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“…Therapeutic alliance early in treatment has been shown to be associated with outcomes (Krupnick et al, 1996), indicating that this is a critical precursor for clients making therapeutic gains in treatment. In addition, studies show us that clients' pretreatment expectancy for change and early homework compliance are important mediators of treatment outcome and can serve as motivation for therapeutic involvement and subsequent treatment gains (Westra, Dozois, & Marcus, 2007).…”

Section: Modifications Of the "Standard" Treatment: Format And Sessiomentioning

confidence: 99%

Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

Rogojanski¹,

Rego²

2013

PCSP

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In their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the microlevel mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights -the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general -integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues' case study by incorporating both empirical research and our own clinical anecdotes.Key words: cognitive behavior therapy; social anxiety disorder; mechanisms of change; exposure therapy; anxiety; case studies; clinical case studies; case series ______________________________________________________________________________We thoroughly enjoyed reading Jensen, Hougaard, and Fishman's (2013) case study of the mechanisms of change in a social phobia client following intensive group-based cognitive behavioral therapy (CBT). This article described Sara, a woman diagnosed with Social Anxiety Disorder who suffered from a primary fear of blushing, and explored mechanisms of change related to her rapid recovery following a brief, intensive treatment. This treatment was based primarily on the work of David Clark and colleagues and comprised of three individual weekly treatment sessions, followed by one week of 5-hour intensive daily group treatment, and five weekly individual follow-up sessions largely for consolidation of treatment gains. Although we're quite familiar with this treatment model and have utilized it with numerous clients individually in our own clinical practices, the authors of this article provide a novel approach for delivering this treatment -in terms of both format and frequency. Being zealous cognitive behavior therapists, we were intrigued by this approach and will focus this commentary on

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The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Cited by 672 publications

References 25 publications

Raising Questions about Antidepressants

Raising Questions about Antidepressants

The impact of personality and personality disorders on the treatment of depression

Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

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