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Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults
Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
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2016 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, 40-51 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2016. Vol. 77, 40-51 p.
Keyword [en]
therapist competence, working alliance, cognitive behavioral therapy, panic disorder, social anxiety disorder
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Research subject
URN: urn:nbn:se:su:diva-125258DOI: 10.1016/j.brat.2015.12.004ISI: 000370899200006OAI: diva2:892224

This study is a part of the adult part of the research project “Assessment and Treatment - Anxiety in Children and Adults. Adult part” (ATACA) and has received support from the Western Norway Regional Health Authority, through project no. 911366 and project no. 911253. Identifier: NCT00619138.

Available from: 2016-01-08 Created: 2016-01-08 Last updated: 2016-06-22Bibliographically approved

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Öst, Lars-Göran
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