Therapeutic Alliance, Attendance, and Outcomes in Youths Receiving CBT or Client-Centered Therapy for Anxiety.

IF 4.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of Clinical Child and Adolescent Psychology Pub Date : 2023-10-05 DOI:10.1080/15374416.2023.2261547

Deepika Bose, Jeremy W Pettit, Jennifer S Silk, Cecile D Ladouceur, Thomas M Olino, Erika E Forbes, Greg J Siegle, Ronald E Dahl, Phillip C Kendall, Neal D Ryan, Dana L McMakin

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Abstract

Objective: Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety.

Method: We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time.

Results: Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance.

Conclusions: Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.

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接受CBT或以客户为中心的焦虑治疗的年轻人的治疗联盟、出勤率和结果。

目的：青年焦虑症文献中记载了治疗联盟与结果（如青年症状严重程度）之间的正相关关系；然而，人们对早期联盟在何种条件下有助于青年取得积极成果知之甚少。本研究调查了青年人的治疗联盟、会议出席率和结果之间的关系（N = 135；55.6%的女性），他们参加了一项随机临床试验，测试认知行为疗法或以客户为中心的焦虑疗法的疗效。方法：我们评估了一个概念模型，其中：（1）早期联盟通过提高会议出席率间接促进积极结果；（2）联盟结果关联因干预类型而异，与以客户为中心的治疗相比，认知行为治疗中的关联更强；（3）联盟结果关联在结果测量时间点上各不相同，早期联盟对结果的影响随着时间的推移而减弱。结果：与假设相反，早期联盟的提供者评分预测了治疗后更高的青年焦虑症状严重程度（即更差的治疗结果）。出席会议预测了积极的青年评价结果，尽管早期联盟通过出席会议对结果没有间接影响。结论：研究结果表明，增加会议出席率对提高结果很重要，不支持将早期联盟作为结果的预测因素。

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来源期刊

Journal of Clinical Child and Adolescent Psychology Multiple-

CiteScore

9.70

自引率

4.80%

发文量

期刊介绍： The Journal of Clinical Child and Adolescent Psychology (JCCAP) is the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association. It publishes original contributions on the following topics: (a) the development and evaluation of assessment and intervention techniques for use with clinical child and adolescent populations; (b) the development and maintenance of clinical child and adolescent problems; (c) cross-cultural and sociodemographic issues that have a clear bearing on clinical child and adolescent psychology in terms of theory, research, or practice; and (d) training and professional practice in clinical child and adolescent psychology, as well as child advocacy.