title: Therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa.
abstract: OBJECTIVE
  The aim of this study was to investigate the strength and role of therapeutic alliance in a trial comparing Cognitive Behavioral Therapy for anorexia nervosa (CBT-AN) and Specialist Supportive Clinical Management for the treatment of severe and enduring AN (SE-AN).
  
  
  METHODS
  Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized controlled trial conducted at two clinical sites. Participants completed measures assessing their perception of the quality of the therapeutic relationship, eating disorder (ED) symptomatology, and depressive symptomatology.
  
  
  RESULTS
  Beyond the effect of early treatment change and treatment assignment, early therapeutic alliance was a significant predictor of Restraint and Shape Concern at follow-up (ps < .02). Late therapeutic alliance was a significant predictor of weight change, depressive symptomatology, and ED symptomatology at end of treatment and follow-up (ps < .008), with the exception of Shape Concern at follow-up (p = .07).
  
  
  CONCLUSIONS
  The results suggest that therapeutic alliance can be effectively established in the treatment of SE-AN and may be relevant for treatment response, particularly in late treatment, on some aspects of ED and depressive symptomatology.
authors.affiliation: Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois.
authors.forename: Colleen
authors.initials: C
authors.lastname: Stiles-Shields
authors.forename: Stephen
authors.initials: S
authors.lastname: Touyz
authors.forename: Phillipa
authors.initials: P
authors.lastname: Hay
authors.forename: Hubert
authors.initials: H
authors.lastname: Lacey
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rieger
authors.forename: Bryony
authors.initials: B
authors.lastname: Bamford
authors.forename: Daniel
authors.initials: D
authors.lastname: Le Grange
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000856:Anorexia Nervosa / Q000523:psychology* / Q000628:therapy*; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006379:Helping Behavior; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: anorexia nervosa; cognitive behavioral therapy; specialist supportive clinical management; therapeutic alliance