Patterns of alliance development in cognitive behavioral therapy versus attention bias modification for social anxiety disorder: Sawtooth patterns and sudden gains

Yogev Kivity*, Asher Y. Strauss, Jonathan Elizur, Michal Weiss, Lior Cohen, Jonathan D. Huppert

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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 languageAmerican English
Pages (from-to)122-136
Number of pages15
JournalJournal of Clinical Psychology
Volume78
Issue number2
DOIs
StatePublished - Feb 2022

Bibliographical note

Publisher Copyright:
© 2021 Wiley Periodicals LLC

Keywords

  • alliance–outcome correlation
  • cognitive behavioral therapy
  • social anxiety disorder
  • sudden gains
  • therapeutic alliance

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