nach oben

Erschienen in:

25.04.2017 | Original Article

Expectancies, Working Alliance, and Outcome in Transdiagnostic and Single Diagnosis Treatment for Anxiety Disorders: An Investigation of Mediation

verfasst von: Shannon Sauer-Zavala, James F. Boswell, Kate H. Bentley, Johanna Thompson-Hollands, Todd J. Farchione, David H. Barlow

Erschienen in: Cognitive Therapy and Research | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Patients’ outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook, Oxford University Press, New York, 2011a; Barlow et al., Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press, 2017b) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP vs. SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance [B = 0.037, SE = 0.05, 95% CI (.005, 0.096)]. Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.

Although change scores were once considered to be unreliable, recent research has demonstrated that they can be reliable measures of intraindividual change (King et al. 2006).

Given the significant difference in number of missing values for post-treatment HARS scores as a function of age, we also ran the models reported in this section controlling for this. As values remained largely unchanged, we report only the uncontrolled models for brevity.

Abouguendia, M., Joyce, A. S., Piper, W. E., & Ogrodniczuk, J. S. (2004). Alliance as a mediator of expectancy effects in short-term group psychotherapy. Group Dynamics, 8, 3–12. doi:10.1037/1089-2699.8.1.3.CrossRef

Ahmed, M., Westra, H. A., & Constantino, M. J. (2012). Early therapy interpersonal process differentiating clients high and low in outcome expectations. Psychotherapy Research, 22, 731–745.CrossRefPubMed

Ake, C. F. (2005). Rounding after multiple imputation with non-binary categorical covariates. Paper presented at the annual meeting of the SAS Users Group International, Philadelphia, PA.

Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55, 1247–1263.CrossRefPubMed

Barlow, D. H., & Craske, M. G. (2007). Mastery of your anxiety and panic: Workbook (4th edn.). New York, NY: Oxford University Press.

Barlow, D. H., Ellard, K. K., Fairholme, C. P., Farchione, T. J., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011a). Unified protocol for transdiagnostic treatment of emotional disorders: Client workbook. New York: Oxford University Press.

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011b). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.

Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Latin, H., Ellard, K. K., Bullis, J. R.,…, Cassiello-Robbins, C. (2017a). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.CrossRef

Barlow, D. H., Sauer-Zavala, S., Farchione, T.J., Latin, H., Ellard, K. K., Bullis, J. R.,…, Cassiello-Robbins, C. (2017b). Unified protocol for transdiagnostic treatment of emotional disorders: Patient workbook. New York: Oxford University Press.CrossRef

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy, Research and Practice, 16, 252–260.CrossRef

Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorders and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70, 288–298. doi:10.1037/0022-006X.70.2.288.CrossRefPubMed

Boswell, J. F. (2013). Intervention strategies and clinical process in transdiagnostic cognitive-behavioral therapy. Psychotherapy, 50, 381–386. doi:10.1037/a0032157.CrossRefPubMed

Boswell, J. F., Bentley, K. H., & Barlow, D. H. (2015). Motivation facilitation in the unified protocol for transdiagnostic treatment of emotional disorders. In H. Arkowitz, W. Miller & S. Rollnick (Eds.), Motivational interviewing in the treatment of psychological problems (2nd edn., pp. 33–57). New York: Guilford Press.

Boswell, J. F., Constantino, M. J., & Anderson, L. M. (2016). Potential obstacles to treatment success in adults: Client characteristics. In S. Maltzman (Ed.), The Oxford handbook of treatment processes and outcomes in psychology. New York: Oxford University Press. doi:10.1093/oxfordhb/9780199739134.013.17.

Brown, T. A., & Barlow, D. H. (2014). Anxiety and related disorders interview schedule for DSM-5—Lifetime version. London: Oxford University Press.

Busseri, M. A., & Tyler, J. D. (2003). Interchangeability of the working alliance inventory and working alliance inventory, Short form. Psychological Assessment, 15, 193–197.CrossRefPubMed

Castonguay, L. G., & Beutler, L. E. (Eds.). (2006). Principles of therapeutic change that work. New York, NY: Oxford University Press.

Castonguay, L. G., Constantino, M. J., Boswell, J. F., & Kraus, D. (2010). The therapeutic alliance: Research and theory. In L. Horowitz & S. Strack (Eds.), Handbook of interpersonal psychology: Theory, research, assessment, and therapeutic interventions (pp. 509–518). New York, NY: Wiley.

Chiles, J. A., Lambert, M. J., & Hatch, A. L. (1999). The impact of psychological interventions on medical cost offset: A meta-analytic review. Clinical Psychology: Science and Practice, 6, 204–220.

Connolly Gibbons, M. B., Crits-Christoph, P., de la Cruz, C., Barber, J. P., Siqueland, L., & Gladis, M. (2003). Pretreatment expectations, interpersonal functioning, and symptoms in the prediction of the therapeutic alliance across supportive-expressive psychotherapy and cognitive therapy. Psychotherapy Research, 13, 59–76.CrossRefPubMed

Constantino, M. J. (2012). Believing is seeing: An evolving research program on patients’ psychotherapy expectations. Psychotherapy Research, 22, 127–138. doi:10.1080/10503307.2012.663512.CrossRefPubMed

Constantino, M. J., Ametrano, R. M., & Greenberg, R. P. (2012). Clinician interventions and participant characteristics that foster adaptive patient expectations for psychotherapy and psychotherapeutic change. Psychotherapy, 49, 557–569. doi:10.1037/a0029440.CrossRefPubMed

Constantino, M. J., Arnow, B. A., Blasey, C., & Agras, W. (2005). The association between patient characteristics and the therapeutic alliance in cognitive-behavioral and interpersonal therapy for bulimia nervosa. Journal of Consulting and Clinical Psychology, 73, 203–211. doi:10.1037/0022-006X.73.2.203.CrossRefPubMed

Constantino, M. J., Boswell, J. F., Bernecker, S. L., & Castonguay, L. G. (2013). Context-responsive integration as a framework for unified psychotherapy and clinical science: Conceptual and empirical considerations. Journal of Unified Psychotherapy and Clinical Science, 2, 1–20.

Constantino, M. J., Coyne, A. E., Mcvicar, E. L., & Ametrano, R. M. (2016). The relative association between individual difference variables and general psychotherapy outcome expectation in socially anxious individuals. Psychotherapy Research, 11, 1–12.

Constantino, M. J., Glass, C. R., Arnkoff, D. B., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence based responsiveness (2nd edn., pp. 354–376). New York, NY: Oxford University Press.CrossRef

Crits-Christoph, P., Connolly Gibbons, M. B., Hamilton, J., Ring-Kurtz, S., & Gallop, R. (2011). The dependability of alliance assessments: The alliance-outcome correlation is larger than you think. Journal of Consulting and Clinical Psychology, 79, 267–278. doi:10.1037/a0023668.CrossRefPubMedPubMedCentral

Devilly, G., & Borkovec, T. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86. doi:10.1016/S0005-7916(00)00012-4.CrossRefPubMed

Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version (ADIS-IV-L). New York, NY: Oxford University Press.

Fairchild, A. J., MacKinnon, D. P., Toborga, M. P., & Taylor, A. B. (2009). R-suared effect-sie measures of mediation analysis. Behavior Research Methods, 41, 486–498.CrossRefPubMedPubMedCentral

Farchione, T. J., Fariholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R.,…, Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43, 666–678.CrossRefPubMedPubMedCentral

Foa, E. B., Yadin, E., & Lichner, T. K. (2008). Obsessive-compulsive disorder: A cognitive-behavioral therapy approach. New York, NY: Oxford University Press.

Fox-Wasylyshyn, S. M., & El-Masri, M. M. (2005). Handling missing data in self-report measures. Research in Nursing & Health, 28(6), 488–495. doi:10.1002/nur.20100.CrossRef

Frank, J. D. (1961). Persuasion and healing: A comparative study of psychotherapy. Oxford: Johns Hopkins University Press.

Gaudiano, B., & Miller, I. (2006). Patients’ expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder. Journal of Consulting and Clinical Psychology, 74, 671–676. doi:10.1037/0022-006X.74.4.671.CrossRefPubMed

Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles. American Psychologist, 35, 991–999. doi:10.1037/0003-066X.35.11.991.CrossRefPubMed

Goldstein, A. P. (1962). Patient-therapist expectancies in psychotherapy. Oxford: Pergamon.

Greenberg, R. P., Constantino, M. J., & Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26, 657–678. doi:10.1016/j.cpr.2005.03.002.CrossRefPubMed

Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.CrossRefPubMed

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: NY: The Guilford Press.

Hollon, S. D., & Beck, A. T. (2013). Cognitive and cognitive-behavioral therapies. In: M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherpay and behavior change (6th edn). Mahwah, NJ: Wiley.

Hope, D. A., Heimberg, R. G., & Turk, C. L. (2006). Managing social anxiety: A cognitive-behavioral therapy approach: Therapist guide. San Antonio, TX: Oxford University Press.

Horvath, A. O., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd edn., pp. 25–69). New York, NY: Oxford University Press.CrossRef

Johansson, P., Høglend, P., & Hersoug, A. (2011). Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy. British Journal of Clinical Psychology, 50, 283–297.PubMed

Joyce, A. S., Ogrodniczuk, J. S., Piper, W. E., & McCallum, M. (2003). The alliance as mediator of expectancy effects in short-term individual therapy. Journal of Consulting and Clinical Psychology, 71, 672–679. doi:10.1037/0022-006X.71.4.672.CrossRefPubMed

Joyce, A. S., & Piper, W. E. (1998). Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. Journal of Psychotherapy Practice and Research, 7, 236–248.PubMedPubMedCentral

Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37. doi:10.1177/1745691610393527.CrossRefPubMed

King, L. A., King, D. W., McArdle, J. J., Saxe, G. N., Doron-Lamarca, S., & Orazen, R. J. (2006). Latent difference score approach to longitudinal trauma research. Journal of Trauma & Stress, 19(6), 771–785.

Kirsch, I. (1985). Response expectancy as a determinant of experience and behavior. American Psychologist, 40, 1189–1202. doi:10.1037/0003-066X.40.11.1189.CrossRef

Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin & Garfield’s handbook of psychotherapy and behavior change (6th edn., pp. 169–218). New York, NY: John Wiley & Sons.

McHugh, R. K., Otto, M. W., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2007). Cost-efficacy of individual and combined treatments for panic disorder. Journal of Clinical Psychiatry, 68, 1038–1044.CrossRefPubMed

Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance and outcome: Further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051–1055. doi:10.1037//0022-006X.70.4.1051.CrossRefPubMed

Montgomery, G. H., & Bovbjerg, D. H. (2004). Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer. Health Psychology, 23, 381–387. doi:10.1037/0278-6133.23.4.381.CrossRefPubMed

Nathan, P. E., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work (4th edn.). New York: Oxford University Press.

Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., & Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies. Journal of Consulting and Clinical Psychology, 79, 171–181.CrossRefPubMedPubMedCentral

Patterson, C. L., Uhlin, B., & Anderson, T. (2008). Clients’ pretreatment counseling expectation as predictors of the working alliance. Journal of Counseling Psychology, 55, 528–534.CrossRefPubMed

Price, M., Anderson, P., Henrich, C., & Rothbaum, B. O. (2008). Greater expectations: Hierarchical linear modeling of expectancies as a predictor of treatment outcome. Behavior Therapy, 39, 398–405. doi:10.1016/j.beth.2007.12.002.CrossRefPubMedPubMedCentral

Price, M., & Anderson, P. L. (2012). Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder. Psychotherapy, 49, 173–179. doi:10.1037/a0024734.CrossRefPubMed

Roth, P. L., Switzer, F. S., & Switzer, D. M. (1999). Missing data in multiple item scales: A Monte Carlo analysis of missing data techniques. Organizational Research Methods, 2(3), 211–232. doi:10.1177/109442819923001.CrossRef

Rutherford, B. R., Wager, T. D., & Roose, S. P. (2010). Expectancy and the treatment of depression: A review of experimental methodology and effects on patient outcome. Current Reviews in Psychiatry, 6, 1–10. doi:10.2174/157340010790596571.CrossRef

Shear, M. K., Vander Bilt, J., & Rucci, P. (2001). Reliability and validity of a structured interview guide for the Hamilton Anxiety Rating Scale (SIGH-A). Depression and Anxiety, 13, 166–178.CrossRefPubMed

Thompson-Hollands, J., Bentley, K. H., Gallagher, M. W., Boswell, J. F., & Barlow, D. H. (2014). Credibility and outcome expectancy in the unified protocol for transdiagnostic treatment of emotional disorders. Journal of Experimental Psychopathology, 5, 72–82. doi:10.5127/jep.033712.CrossRef

Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1, 207–210.CrossRef

Tsai, M., Ogrodniczuk, J. S., Sochting, I., & Mirmiran, J. (2014). Forecasting success: Patients’ expectations for improvement and their relations to baseline, process and outcome variables in group cognitive-behavioural therapy for depression. Clinical Psychology and Psychotherapy, 21, 97–107. doi:10.1002/cpp.1831.CrossRefPubMed

Vogel, P. A., Hansen, B., Stiles, T. C., & Götestam, K. (2006). Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. Journal of Behavior Therapy and Experimental Psychiatry, 37, 247–255. doi:10.1016/j.jbtep.2005.12.001.CrossRefPubMed

Webb, C. A., Kertz, S. J., Bigda-Peyton, J. S., & Björgvinsson, T. (2013). The role of pretreatment outcome expectancies and cognitive–behavioral skills in symptom improvement in an acute psychiatric setting. Journal of Affective Disorders, 149, 375–382. doi:10.1016/j.jad.2013.02.016.CrossRefPubMedPubMedCentral

Weinberger, L., & Eig, A. (1999). Expectancies: The ignored common factor in psychotherapy. In I. Kirsch (Ed.), How expectancies shape experience (pp. 357–382). Washington, DC: American Psychological Association. doi:10.1037/10332-015.CrossRef

Westra, H. A., Constantino, M. J., & Aviram, A. (2011). The impact of alliance ruptures on client outcome expectations in cognitive behavioral therapy. Psychotherapy Research, 21, 472–481. doi:10.1080/10503307.2011.581708.CrossRefPubMed

Zack, S. E., Castonguay, L. G., Boswell, J. F., McAleavey, A. A., Adelman, R., Kraus, D. R., & Pate, G. A. (2015). Attachment history as a moderator of the alliance-outcome relationship in adolescents. Psychotherapy, 52, 258–267. 10.1037/a0037727.CrossRefPubMed

Zinbarg, R., Craske, M., & Barlow, D. H. (2006). Therapist’s guide for the mastery of your anxiety and worry program. New York, NY: Oxford University Press.CrossRef

Titel: Expectancies, Working Alliance, and Outcome in Transdiagnostic and Single Diagnosis Treatment for Anxiety Disorders: An Investigation of Mediation
verfasst von: Shannon Sauer-Zavala
James F. Boswell
Kate H. Bentley
Johanna Thompson-Hollands
Todd J. Farchione
David H. Barlow
Publikationsdatum: 25.04.2017
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 2/2018
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-017-9855-8

Neu im Fachgebiet Psychiatrie

23.04.2024 | Demenz | Nachrichten

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Expectancies, Working Alliance, and Outcome in Transdiagnostic and Single Diagnosis Treatment for Anxiety Disorders: An Investigation of Mediation

Abstract

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

Update Psychiatrie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2018

Increased Attention Regulation from Emotion Regulation Therapy for Generalized Anxiety Disorder

Miles to Go Before We Sleep: Advancing the Understanding of Psychotherapy by Modeling Complex Processes

Introduction to the Special Issue on Processes of Cognitive Behavioral Therapy: Does “Necessary, But Not Sufficient” Still Capture It?

Using Motivational Interviewing to Manage Process Markers of Ambivalence and Resistance in Cognitive Behavioral Therapy

Reports of Therapy Skill Use and Their Efficacy in Daily Life in the Short-Term Treatment of Depression

Methods of Delivering Progress Feedback to Optimise Patient Outcomes: The Value of Expected Treatment Trajectories

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

Update Psychiatrie