Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia

Behav Res Ther. 2014 Jan:52:26-34. doi: 10.1016/j.brat.2013.11.001. Epub 2013 Nov 12.

Abstract

Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients' contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients' contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists' contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes.

Keywords: Alliance; CBT; Cognitive behavioral therapy; Panic disorder; Therapist effects.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Agoraphobia / psychology*
  • Agoraphobia / therapy
  • Cognitive Behavioral Therapy / methods
  • Female
  • Health Personnel / psychology*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Models, Psychological
  • Multicenter Studies as Topic
  • Panic Disorder / psychology*
  • Panic Disorder / therapy
  • Patient Compliance / psychology*
  • Professional-Patient Relations*
  • Treatment Outcome