title: Effects of religious vs. standard cognitive behavioral therapy on therapeutic alliance: A randomized clinical trial.
abstract: BACKGROUND
  Treatments that integrate religious clients' beliefs into therapy may enhance the therapeutic alliance (TA) in religious clients.
  
  
  OBJECTIVE
  Compare the effects of religiously integrated cognitive behavioral therapy (RCBT) and standard CBT (SCBT) on TA in adults with major depression and chronic medical illness.
  
  
  METHODS
  Multi-site randomized controlled trial in 132 participants, of whom 108 (SCBT = 53, RCBT = 55) completed the Revised Helping Alliance Questionnaire (HAQ-II) at 4, 8, and 12 weeks. Trajectory of change in scores over time was compared between groups.
  
  
  RESULTS
  HAQ-II score at 4 weeks predicted a decline in depressive symptoms over time independent of treatment group (B = -0.06, SE = 0.02, p = 0.002, n = 108). There was a marginally significant difference in HAQ-II scores at 4 weeks that favored RCBT (p = 0.076); however, the mixed effects model indicated a significant group by time interaction that favored the SCBT group (B = 1.84, SE = 0.90, degrees of freedom = 181, t = 2.04, p = 0.043, d = 0.30).
  
  
  CONCLUSIONS
  While RCBT produces a marginally greater improvement in TA initially compared with SCBT, SCBT soon catches up.
authors: a Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors: Harold G
authors: HG
authors: Koenig
authors: b School of Medicine , University of Maryland , Baltimore , MD , USA.
authors: Michelle
authors: M
authors: Pearce
authors: c Department of Research , Glendale Adventist Medical Center , Glendale , CA , USA.
authors: Bruce
authors: B
authors: Nelson
authors: c Department of Research , Glendale Adventist Medical Center , Glendale , CA , USA.
authors: Sally
authors: S
authors: Shaw
authors: d Department of Psychology and Neuroscience , Duke University Medical Center , Durham , NC , USA.
authors: Clive
authors: C
authors: Robins
authors: e Epidemiology, Biostatistics, and Population Medicine, School of Public Health , Loma Linda University , Loma Linda , CA , USA.
authors: Noha
authors: N
authors: Daher
authors: f Department of Medicine , Duke University Medical Center , Durham , NC , USA.
authors: Harvey Jay
authors: HJ
authors: Cohen
authors: g Division of Psychiatry, Faculty of Brain Sciences , University College London , London , UK.
authors: Michael B
authors: MB
authors: King
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011369:Professional-Patient Relations; D012069:Religion and Psychology
keywords: CBT; chronic illness; major depression; psychotherapy; religious; spiritual; therapeutic alliance