title: How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization.
abstract: OBJECTIVE
  There has been little research on the development of the therapeutic alliance in cognitive behavioral therapy (CBT). This study aims to examine the development of therapeutic alliance in CBT for panic disorder.
  
  
  METHODS
  Nineteen patients were treated with CBT for panic disorder. Pre- and post-session data of the therapeutic alliance and panic symptoms and cognitions were collected.
  
  
  RESULTS
  Several patterns were observed, including a sawtooth pattern (within-session improvements followed by decline between sessions; 63% of the patients), sudden gains in the alliance (58%), and late stabilization (89%). The sawtooth pattern was related to less symptom reduction between sessions (explained variance = 20-48%). Though not statistically significant, there were moderate effect sizes for the relationships between outcomes and early alliance and sudden gains (explained variance = 13-17%).
  
  
  CONCLUSIONS
  Overall, results suggest that intensive data collection is likely to yield understanding of the relationship between therapy processes and outcomes.
authors: a Psychology , The Hebrew University of Jerusalem , Jerusalem , Israel.
authors: Michal
authors: M
authors: Weiss
authors: Yogev
authors: Y
authors: Kivity
authors: Jonathan D
authors: JD
authors: Huppert
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000523:psychology / Q000628:therapy*; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D013811:Psychotherapeutic Processes; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult