The therapeutic alliance in exposure therapy for anxiety-related disorders: A critical review

Buchholz, Jennifer L.; Abramowitz, Jonathan S.

doi:10.1016/j.janxdis.2020.102194

Cited by 46 publications

(46 citation statements)

References 58 publications

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“…The use of instruments measuring working alliance from two different theoretical perspectives provides an interesting perspective. The CALPAS has been used less frequently in studies on CBT (Buchholz and Abramowitz, 2020) and provides information that complements the WAI, such as patient working capacity, patient commitment and therapists understanding and involvement. This is reassuring for mental health professionals who may worry that using technology to remotely deliver psychotherapy may pose significant threat to the working alliance and the therapeutic relationship (e.g., Rees and Stone, 2005).…”

Section: Discussionmentioning

confidence: 99%

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Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

et al. 2020

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Background: In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. Methods: This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. Results: Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Noninferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the

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Section: Discussionmentioning

confidence: 99%

“…California Psychotherapy Alliance Scale (CALPAS; Marmar et al, 1986) The CALPAS is another self-rated measure of alliance. This 24item instrument was also administered to provide a different and complementary perspective on the working alliance (Bachelor and Salamé, 2000;Buchholz and Abramowitz, 2020).…”

Section: Methodsmentioning

confidence: 99%

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

et al. 2020

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“…Based on the above, we developed the following hypotheses: The Hungarian translation of the EFT‐KACS is a reliable instrument. EFT Externship trainings in Hungary through translation have similar effectiveness with trainings in other parts of the world: Participants’ self‐reported knowledge of EFT will increase with the 4‐day training. Participants’ self‐reported competency of EFT will increase with the 4‐day training, but to a lesser extent than their knowledge. Participants’ self‐reported client–therapist alliance will remain the same before and after the 4‐day training, because it is not specifically linked to EFT skills (Buchholz & Abramowitz, 2020). Background characteristics of participants will moderate the effectiveness of the training. …”

Section: Measuring Eft Training Outcomesmentioning

confidence: 99%

Measuring the Effectiveness of the Emotionally Focused Therapy Externship Training in Hungary done through Translation

Koren

Woolley

Danis

et al. 2020

J Marital Family Therapy

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Our study adds to the rising field of dissemination and implementation research on Emotionally Focused Therapy. We evaluated the psychometric characteristics of the Hungarian EFT‐KACS, examined the impact of the EFT Externship training done through translation on Hungarian therapists, and we investigated how therapist background characteristics related to outcomes. A total of 340 Hungarian professionals completed the questionnaires (N = 152 in 2016; and N = 188 in 2018) at three data collecting points—prior to (N = 329), after the training (N = 254), and 6 months later (N = 101). Results suggest the Hungarian EFT‐KACS has similar psychometric properties as the original English version and shows high internal consistency. The 4‐day EFT Externship trainings done through translation provided significant, lasting increases in perceived EFT‐specific knowledge and competency, and in alliance, similar to findings in English‐ and Spanish‐speaking countries. Externship outcomes were also found to be related to specific therapist experience and background characteristics.

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“…It explained 5% [9] to 7.5% [13] of the variance in treatment outcome. More recently, Buchholz and Abramowitz [14] critically reviewed the literature on the working alliance during CBT for anxiety disorders. Their findings highlighted the need for more studies on the contribution of the working alliance to treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Their findings highlighted the need for more studies on the contribution of the working alliance to treatment outcome. They found 7 studies on anxiety disorders, suggesting that the global measures of alliance predicted treatment outcome, and 4 studies that did not find this result [14]. The authors found only 3 studies that investigated the specific role of the components of the working alliance.…”

Section: Introductionmentioning

confidence: 99%

The Role of Intolerance of Uncertainty and Working Alliance in the Outcome of Cognitive Behavioral Therapy for Generalized Anxiety Disorder Delivered by Videoconference: Mediation Analysis

Marcotte-Beaumier¹,

Bouchard²,

Patrick³

et al. 2021

JMIR Ment Health

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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.

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The therapeutic alliance in exposure therapy for anxiety-related disorders: A critical review

Cited by 46 publications

References 58 publications

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

Videoconferencing Psychotherapy for Panic Disorder and Agoraphobia: Outcome and Treatment Processes From a Non-randomized Non-inferiority Trial

Measuring the Effectiveness of the Emotionally Focused Therapy Externship Training in Hungary done through Translation

The Role of Intolerance of Uncertainty and Working Alliance in the Outcome of Cognitive Behavioral Therapy for Generalized Anxiety Disorder Delivered by Videoconference: Mediation Analysis

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