Abstract
Objectives: We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within- and decreases between-sessions) and sudden gains and their association with outcome. Methods: Clients received CBT (n = 33) or ABM (n = 17). Client-rated alliance was measured before and after each session. Self-reported and clinician-rated anxiety were measured weekly and monthly, respectively. Results: The alliance increased in CBT in a sawtooth pattern and did not change in ABM. When examining individual clients, sawtooths were more common in CBT (61% clients) than in ABM (6%) and predicted worse outcome in CBT. Sudden gains were equally frequent (CBT, 18%; ABM, 18%) and did not predict outcome. Conclusion: The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome.
| Original language | American English |
|---|---|
| Pages (from-to) | 122-136 |
| Number of pages | 15 |
| Journal | Journal of Clinical Psychology |
| Volume | 78 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2022 |
Bibliographical note
Funding Information:The authors thank Robert J. DeRubeis for his assistance in conceptualizing the data analytic approach. The authors would like to thank Roni Pener‐Tessler, Ariela Friedman, Yael Milgram, Shai Avishay, Michal Kovacs, and Maayan Langmass for their help in data collection. This study was supported by a grant from the Israel Science Foundation (grant #332/09) to the last author, the Sam and Helen Beber Chair of Clinical Psychology at The Hebrew University. The funding sources did not have any involvement in conducting the study and preparing the manuscript.
Publisher Copyright:
© 2021 Wiley Periodicals LLC
Keywords
- alliance-outcome correlation
- alliance–outcome correlation
- cognitive behavioral therapy
- social anxiety disorder
- sudden gains
- therapeutic alliance