title: Therapist effects and the outcome-alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia.
abstract: Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients' contribution to the alliance on outcome and attrition in one trial. Alliance ratings were obtained from patients and therapists early and late in treatment (n = 133). Data were analyzed using multi-level modeling controlling for early symptom change. No therapist effects were found. The patients' contribution to the alliance predicted outcome (in both panic severity and anxiety sensitivity) and attrition. The therapists' contribution to the alliance predicted attrition but not outcome. Results suggest that the patient's contribution to the alliance plays an important role in CBT for PDA and that including common factors into research on CBT may help elucidate treatment processes.
authors.affiliation: Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Huppert
authors.affiliation: Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel.
authors.forename: Yogev
authors.initials: Y
authors.lastname: Kivity
authors.affiliation: Center for Anxiety and Related Disorders, Department of Psychology, Boston University, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
authors.affiliation: Comprehensive NeuroScience Inc., USA.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Gorman
authors.affiliation: School of Social Work, Columbia University, USA.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.affiliation: Department of Psychiatry, Yale University, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Woods
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000523:psychology* / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015337:Multicenter Studies as Topic; D016584:Panic Disorder / Q000523:psychology* / Q000628:therapy; D010349:Patient Compliance / Q000523:psychology*; D011369:Professional-Patient Relations; D016896:Treatment Outcome
keywords: Alliance; CBT; Cognitive behavioral therapy; Panic disorder; Therapist effects