title: The relationship between the therapeutic alliance and treatment outcome in two distinct psychotherapies for chronic depression.
abstract: OBJECTIVE
  This study tested whether the quality of the patient-rated working alliance, measured early in treatment, predicted subsequent symptom reduction in chronically depressed patients. Secondarily, the study assessed whether the relationship between early alliance and response to treatment differed between patients receiving cognitive behavioral analysis system of psychotherapy (CBASP) vs. brief supportive psychotherapy (BSP).
  
  
  METHODS
  395 adults (57% female; Mage = 46; 91% Caucasian) who met criteria for chronic depression and did not fully remit during a 12-week algorithm-based, open-label pharmacotherapy trial were randomized to receive either 16-20 sessions of CBASP or BSP in addition to continued, algorithm-based antidepressant medication. Of these, 224 patients completed the Working Alliance Inventory-Short Form at Weeks 2 or 4 of treatment. Blind raters assessed depressive symptoms at 2-week intervals across treatment using the Hamilton Rating Scale for Depression. Linear mixed models tested the association between early alliance and subsequent symptom ratings while accounting for early symptom change.
  
  
  RESULTS
  A more positive early working alliance was associated with lower subsequent symptom ratings in both the CBASP and BSP, F(1, 1236) = 62.48, p < .001. In addition, the interaction between alliance and psychotherapy type was significant, such that alliance quality was more strongly associated with symptom ratings among those in the CBASP treatment group, F(1, 1234) = 8.31, p = .004.
  
  
  CONCLUSIONS
  The results support the role of the therapeutic alliance as a predictor of outcome across dissimilar treatments for chronic depression. Contrary to expectations, the therapeutic alliance was more strongly related to outcome in CBASP, the more directive of the 2 therapies.
authors: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5722, USA.arnow@stanford.edu
authors: Bruce A
authors: BA
authors: Arnow
authors: Dana
authors: D
authors: Steidtmann
authors: Christine
authors: C
authors: Blasey
authors: Rachel
authors: R
authors: Manber
authors: Michael J
authors: MJ
authors: Constantino
authors: Daniel N
authors: DN
authors: Klein
authors: John C
authors: JC
authors: Markowitz
authors: Barbara O
authors: BO
authors: Rothbaum
authors: Michael E
authors: ME
authors: Thase
authors: Aaron J
authors: AJ
authors: Fisher
authors: James H
authors: JH
authors: Kocsis
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents