Brief reportInterpersonal problems as predictors of alliance, symptomatic improvement and premature termination in treatment of depression
Section snippets
Background
Interpersonal problems are common in depression. Not only do depressed patients report high interpersonal distress, they also describe specific problems related to low assertiveness such as social avoidance, submissiveness and exploitation (Barrett and Barber, 2007). But how do these issues relate to the process and outcome of treatment for depression?
Previous research examining the influence of interpersonal distress on outcome has failed to provide definitive answers. For example, Renner et
Participants and procedure
Details about inclusion criteria and study procedures are reported by Barber et al. (2012). The current sample consisted of 151 patients, mean age was 37.5 years (SD=12.12), 60.9% were female. Ethnicities included Caucasian (49%), African American (44%), Latino (5%) and Asian (2%). All patients met DSM-IV criteria for Major Depressive Disorder, and 85% had at least one comorbid disorder. Interpersonal problems, depressive symptoms and therapeutic alliance were assessed at intake by independent
Correlations at intake
At intake, the level of interpersonal distress did not correlate significantly with depression severity (r=0.15; p=0.062), but was associated with lower alliance expectations (r=−0.21, p=0.015). Although communion correlated with alliance expectations (r=0.30, p=0.001), agency was not related to either alliance or initial symptom severity (r′s between −0.01 and .05).
Interpersonal problems as predictors of alliance throughout treatment
Interpersonal distress as well as communion predicted alliance intercepts (see Table 1). Alliance scores showed a significant
Discussion
This study examined the influence of interpersonal problems on treatment alliance, outcome and premature termination in three treatments for depression. Overall, high levels of interpersonal distress predicted lower expectations for alliance at intake. Several previous studies found that patients with high interpersonal disturbances have difficulties in forming positive therapeutic alliances (e.g., Constantino and Smith-Hansen, 2008). However, previous studies were less consistent regarding the
Conclusions
The current study demonstrates that interpersonal problems predict therapeutic alliance, treatment outcome, and premature termination in treatments for depression, with findings partially dependent on treatment type. As depressive patients frequently experience interpersonal problems related to submissiveness, the role of low agency in psychotherapy should be investigated in future studies.
Role of funding source
The original study was conducted with support from NIMH grant R01 MH 061410 to J. P. Barber (P.I.). The sertraline and pill placebos were provided by a grant from Pfizer Corp. The current study was written with support from the German Research Foundation, grant number: DI 1690/2 to U. Dinger.
Conflict of interest
Dr. Dinger has received funding from the German Research Foundation (DFG). Dr. Barber has received funding from the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA); authors' fees from Guilford Press, Basic Books, and Cambridge University Press; and honoraria from Lundbeck. The other authors declare no conflict of interest.
Acknowledgments
We are grateful to the research team at the University of Pennsylvania and to those colleagues who were involved in and supported the primary trial.
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