Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults
Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults
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DOI：
10.1016/j.brat.2015.12.004
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发表时间：
2016-02-01
影响因子：
4.1
通讯作者：
Havik, Odd E.
中科院分区：
文献类型：
--
作者：
Haug, Thomas;Nordgreen, Tine;Havik, Odd E.
目的：工作联盟和治疗师的能力/依从性和认知行为治疗（CBT）的结果之间的关联的研究是有限的，其特点是不确定的结果。本研究旨在探讨工作联盟和能力/依从性对社交焦虑障碍（SAD）和惊恐障碍（PD）患者CBT治疗效果的预测作用。（58.5%为女性;年龄：M = 33.6岁，SD = 103）伴PD（n = 31）或SAD（n = 51）在一项随机对照有效性试验中，由22名CBT经验有限的临床医生进行12次手动CBT治疗。独立评估员使用修订版的认知治疗依从性和能力量表对治疗师的CBT能力/依从性进行评分，患者使用工作联盟量表在治疗会话3和8中对工作联盟的质量进行评分。结果由独立评估员和患者自我报告进行评估。共有20.7%的患者（27.5% SAD，9.7% PD）在治疗期间脱落。结果：PD患者早期治疗能力/依从性越高，治疗效果越好; SAD患者早期治疗能力/依从性越低，治疗效果越好;较高的评级的联盟在治疗后期与一个更好的结果，而较低的联盟评级在治疗后期与dropout.Conclusion：研究结果表明，治疗师的能力/坚持和工作联盟有独立的贡献，从CBT焦虑症的结果，但在不同阶段的治疗。(C)2015爱思唯尔有限公司版权所有。
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 = 103) 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. (C) 2015 Elsevier Ltd. All rights reserved.