Thomas Haug1, Tine Nordgreen2, Lars-Göran Öst3, Tone Tangen4, Gerd Kvale2, Ole Johan Hovland5, Einar R Heiervang6, Odd E Havik2. 1. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway. Electronic address: Thomas.haug@psykp.uib.no. 2. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Clinical Psychology, University of Bergen, Postboks 7800, 5020 Bergen, Norway. 3. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychology, University of Stockholm, SE-106 91 Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden. 4. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Psychiatry, University of Bergen, Postboks 7800, 5020 Bergen, Norway. 5. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway. 6. Anxiety Disorders Research Network, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171, Blindern, 0318 Oslo, Norway.
Abstract
OBJECTIVE: The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). METHOD:Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. RESULTS: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. CONCLUSION: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.
RCT Entities:
OBJECTIVE: The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). METHOD: Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. RESULTS: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PDpatients, lower competence/adherence was associated with dropout among SADpatients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. CONCLUSION: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.
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