title: The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy.
abstract: Although patients' expectation for improvement correlates with their treatment outcome, there remains limited information regarding the mechanisms through which outcome expectation influences outcome. Although several studies have revealed alliance as a mediator of the expectancy-outcome relation, most have focused on individual psychotherapy only. More research is needed examining mediators, including alliance quality, of the outcome expectation-outcome relation in group therapy.
  
  
  
  This study focused on such associative chains among 91 depressed outpatients who completed 10 weeks of group cognitive-behavioral therapy. We conducted simple and multiple mediation analyses, accounting for the nested data structure.
  
  
  
  As predicted, we found: (i) The relations between baseline outcome expectation and both posttreatment anxiety and depression were mediated by alliance quality; (ii) the early therapy outcome expectation-posttreatment anxiety relation was mediated by mid-treatment alliance; (iii) the relation between early alliance and posttreatment interpersonal problems was mediated by during-therapy outcome expectation; and (iv) the relation between baseline outcome expectation and posttreatment interpersonal problems was mediated by two variables acting in turn, early alliance and during-therapy outcome expectation. All other tested models were not significant.
  
  
  
  Results suggest that bidirectional relations between outcome expectation and alliance, with both directions influencing outcome. Clinical and empirical implications are discussed.
authors: a Department of Psychology , University of Zurich , Zurich , Switzerland.|b Department of Educational Sciences , Stefan cel Mare University of Suceava , Suceava , Romania.
authors: Andreea
authors: A
authors: Vîslă
authors: c Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.
authors: Michael J
authors: MJ
authors: Constantino
authors: c Department of Psychological and Brain Sciences , University of Massachusetts Amherst , Amherst , MA , USA.
authors: Katie
authors: K
authors: Newkirk
authors: d Department of Psychiatry , University of British Columbia , Vancouver , Canada.
authors: John S
authors: JS
authors: Ogrodniczuk
authors: e Department of Psychology , University of British Columbia , Vancouver , Canada.
authors: Ingrid
authors: I
authors: Söchting
mesh_terms: D000328:Adult; D059031:Anticipation, Psychological; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011615:Psychotherapy, Group / Q000379:methods*; D000078462:Therapeutic Alliance
keywords: alliance; depression; group CBT; mediation; outcome; outcome expectation