Treatment adherence, therapeutic alliance, and clinical outcomes during an exposure-based cognitive-behavioral therapy for pediatric irritability.

IF 3.4 2区医学 Q2 PSYCHIATRY BMC Psychiatry Pub Date : 2025-02-26 DOI:10.1186/s12888-025-06601-0

Reut Naim, Ramaris E German, Jamell White, Urmi Pandya, Kelly Dombek, Michal Clayton, Samantha Perlstein, Lauren M Henry, Katharina Kircanski, Lorenzo Lorenzo-Luaces, Melissa A Brotman

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Abstract

Background: This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.

Methods: Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.

Results: First, adherence to standard treatment elements decreased over time (Bs ≥ - 0.03, ps ≤ 0.010), while the focus on specific treatment components increased (i.e., exposure: B = 0.15, p = 0.001; PMT: B = 0.07, p = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (Bs ≥ - 2.23, p ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (Bs ≥ 0.10, p ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (Bs ≥ - 0.66, p ≤ 0.053), and decreases in clinician- (Bs ≥ - 0.02, ps ≤ 0.043) and parent- (B = - 0.15, p = 0.024) reported irritability predicted increased alliance at next session.

Conclusions: Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.

Trial registration: ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.

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治疗依从性，治疗联盟，在暴露为基础的认知行为治疗儿科易怒的临床结果。

背景：本研究探讨了一种新型家长和儿童心理疗法治疗儿童易怒的依从性和联盟性的变化。研究了治疗过程与症状改变之间的关系。方法：40例受试者(平均年龄11.23岁，SD = 1.85；37.5%的女性，77.5%的白人)和他们的父母接受了12次基于暴露的认知行为治疗（CBT）和家长管理培训（PMT）。测量方法包括临床医生评定的手册依从性，联盟量表(儿童联盟量表-修订；TASC-r与工作联盟量表；（分别为WAI），以及临床医生、家长和儿童报告的易怒量表(情感反应指数；ARI)。线性混合模型检查了每一次的变化以及依从性/联盟性与随后的易怒之间的联系，反之亦然。结果：首先，随着时间的推移，对标准治疗成分的依从性降低（Bs≥- 0.03,ps≤0.010），而对特定治疗成分的关注增加(即暴露：B = 0.15, p = 0.001；PMT: B = 0.07, p = 0.002)。其次，坚持标准治疗元素与临床报告的易怒程度降低相关（Bs≥- 2.23,p≤0.042）。对于联盟措施，父母报告的联盟随着时间的推移而增加（Bs≥0.10,p≤0.01）；儿童报告的联盟没有改变。联盟与症状之间存在双向关联；具体而言，儿童报告的联盟预测下一阶段临床评定的易怒程度（Bs≥- 0.66,p≤0.053），临床医生（Bs≥- 0.02,ps≤0.043）和家长（B = - 0.15, p = 0.024）报告的易怒程度的降低预测下一阶段临床报告的联盟程度增加。结论：研究结果强调了治疗依从性和治疗联盟对结果的预测作用，在基于暴露的儿童易怒的CBT治疗中。试验注册：ClinicalTrials.gov标识符：NCT02531893；注册日期：2015年8月25日。

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来源期刊

BMC Psychiatry 医学-精神病学

CiteScore

5.90

自引率

4.50%

发文量

716

审稿时长

3-6 weeks

期刊介绍： BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.