title: Change in patients' interpersonal impacts as a mediator of the alliance-outcome association in treatment for chronic depression.
abstract: OBJECTIVE
  Theories posit that chronically depressed individuals have hostile and submissive interpersonal styles that undermine their interpersonal effectiveness and contribute to the cause and maintenance of their depression. Recent findings support this theory and demonstrate that chronically depressed patients' interpersonal impacts on their therapist become more adaptive (i.e., less hostile and submissive, and more friendly and assertive) during a targeted chronic depression treatment: cognitive-behavioral analysis system of psychotherapy (CBASP). In this study, the authors examined whether such changes in interpersonal impacts (as rated by clinicians' experiences of interacting with their patients) mediated the association between early patient-rated alliance quality and final session depression.
  
  
  METHODS
  Data derived from a large trial for chronic depression that compared the efficacy of CBASP, nefazodone, and their combination. The current subsample (N = 220) included patients in the CBASP and combined conditions who completed at least 1 depression assessment and the alliance measure, and whose therapists completed at least 1 interpersonal impacts assessment. Mediation models were fit using a bootstrapping procedure for assessing indirect effects.
  
  
  RESULTS
  As hypothesized, results supported a mediating effect; higher early alliance predicted decreases in patient hostile-submissiveness during therapy, which in turn related to lower final session depression (indirect effect B = -.02, 95% confidence interval: -.07, -.001). This indirect effect accounted for 13% of the total effect of alliance on depression. There was no moderating effect of treatment condition on the indirect effect.
  
  
  CONCLUSIONS
  Results further support CBASP change theory and suggest a candidate mechanism of the alliance's effect on outcome. (PsycINFO Database Record
authors.affiliation: Department of Psychological and Brain Sciences, University of Massachusetts Amherst.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Constantino
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: Holly B
authors.initials: HB
authors.lastname: Laws
authors.affiliation: Department of Psychological and Brain Sciences, University of Massachusetts Amherst.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Coyne
authors.affiliation: Department of Psychiatry and Behavioral Science, State University of New York Upstate Medical University.
authors.forename: Roger P
authors.initials: RP
authors.lastname: Greenberg
authors.affiliation: Department of Psychology, State University of New York at Stony Brook.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center.
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.affiliation: Department of Psychiatry, Emory University School of Medicine.
authors.forename: Barbara O
authors.initials: BO
authors.lastname: Rothbaum
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011369:Professional-Patient Relations