Abstract
Objective: This study examines relationships among different aspects of therapeutic alliance with treatment outcome, adherence and attrition in internet delivered cognitive behavioral therapy (ICBT) for panic disorder.
Methods: We examined alliance-outcome relationships in ICBT (N = 74) using a newly developed self-report alliance measure that disentangles alliance with program content (Internet Patient’s Experience of Attunement and Responsiveness with the program; I-PEARp) and with the therapist (I-PEARt). We compared ICBT outcomes of patient rated and therapist-rated alliance with conventional alliance scales (WAI-6 and WAI-T).
Results: Consistent with our hypothesis, I-PEARp and I-PEARt distinguished between different aspects of the alliance and predicted outcomes better than standard alliance scales. Furthermore, higher ratings of I-PEARp were associated with subsequent lower symptoms and lower symptoms were associated with higher subsequent alliance. In contrast, I-PEARt predicted adherence, but not symptoms. Although therapists’ ratings of alliance (thI-PEAR) improved significantly during treatment, they did not predict subsequent symptoms, adherence, or dropout.
Conclusion: Results indicate that the patient experience of the alliance in ICBT includes two aspects, each of which uniquely contributes to outcomes; patient connection to the program is related to symptom outcomes whereas the dyadic relationship with the therapist serves as the glue to allow the treatment to hold.
Original language | English |
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Pages (from-to) | 1022-1035 |
Number of pages | 14 |
Journal | Psychotherapy Research |
Volume | 31 |
Issue number | 8 |
Early online date | 10 Feb 2021 |
DOIs | |
Publication status | Published - 2021 |
Bibliographical note
Funding Information:This research was funded by the Israel National Institute for Health Policy Research [grant number 2015/181], awarded to Jonathan D. Huppert, Sam and Helen Beber Chair of Clinical Psychology in the Department of Psychology at The Hebrew University.
Publisher Copyright:
© 2021 Society for Psychotherapy Research.
Funding
This research was funded by the Israel National Institute for Health Policy Research [grant number 2015/181], awarded to Jonathan D. Huppert, Sam and Helen Beber Chair of Clinical Psychology in the Department of Psychology at The Hebrew University.
Keywords
- adherence
- dropout
- I-PEAR
- ICBT
- internet alliance
- internet intervention
- symptom reduction