title: Therapist-youth agreement on alliance change predicts long-term outcome in CBT for anxiety disorders.
abstract: BACKGROUND
  In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whether, and from whose perspective, the alliance predicts outcome. We examined whether youth- and therapist-rated alliance, including level of youth-therapist alliance agreement, predicted outcome in a randomized controlled trial.
  
  
  METHODS
  Youth (N = 91, M age = 11.4 years (SD = 2.1), 49.5% boys, 86.8% Caucasian) diagnosed with separation anxiety disorder, social phobia, or generalized anxiety disorder drawn from the ICBT condition of an effectiveness trial were treated with an ICBT program. Youth- and therapist-rated alliance ratings, assessed with the Therapeutic Alliance Scale for Children (TASC-C/T), were collected following session 3 (early) and 7 (late). Early alliance, change in alliance from early to late, and level of youth-therapist agreement on early alliance and alliance change were examined, in relation to outcomes collected at posttreatment and 1-year follow-up. Outcome was defined as primary diagnosis loss and reduction in clinicians' severity ratings (CSR; Anxiety Disorders Interview Schedule; ADIS-C/P) based on youth- and parent-report at posttreatment and follow-up, and youth treatment satisfaction collected at posttreatment (Client Satisfaction Scale; CSS).
  
  
  RESULTS
  Early TASC-C scores positively predicted treatment satisfaction at posttreatment. Higher levels of agreement on change in TASC-C and TASC-T scores early to late in treatment predicted diagnosis loss and CSR reduction at follow-up.
  
  
  CONCLUSIONS
  Only the level of agreement in alliance change predicted follow-up outcomes in ICBT for youth anxiety disorders. The findings support further examination of the role that youth-therapist alliance discrepancies may play in promoting positive outcomes in ICBT for youth anxiety disorders. Clinical trial number NCT00586586, clinicaltrials.gov.
authors.affiliation: Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Krister W
authors.initials: KW
authors.lastname: Fjermestad
authors.affiliation: Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Matthew D
authors.identifier: http://orcid.org/0000-0002-7373-6663
authors.initials: MD
authors.lastname: Lerner
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Bryce D
authors.initials: BD
authors.lastname: McLeod
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Gro Janne H
authors.initials: GJ
authors.lastname: Wergeland
authors.affiliation: Institute of Clinical Medicine, Child and Adolescent Psychiatry Unit, University of Oslo, Oslo, Norway.
authors.forename: Einar R
authors.initials: ER
authors.lastname: Heiervang
authors.affiliation: Child Study Center, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Silverman
authors.affiliation: Division of Psychology, Stockholm University, Stockholm, Sweden.
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Öst
authors.affiliation: Department of Psychology, University of Maryland, College Park, MD, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: De Los Reyes
authors.affiliation: Department of Clinical Psychology, University of Bergen, Bergen, Norway.
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
authors.affiliation: Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Bente S M
authors.initials: BS
authors.lastname: Haugland
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000628:therapy*; D001010:Anxiety, Separation / Q000628:therapy; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D000072861:Phobia, Social / Q000628:therapy; D011369:Professional-Patient Relations
keywords: Alliance; CBT; alliance agreement; anxiety; youth