Luong Hoang K, Drummond Sean P A, Norton Peter J
School of Psychological Sciences, Monash University, Victoria, Australia.
The Cairnmillar Institute, Hawthorn East, Victoria, Australia.
J Anxiety Disord. 2020 Dec;76:102322. doi: 10.1016/j.janxdis.2020.102322. Epub 2020 Oct 2.
To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential "active ingredient" of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.
为优化认知行为疗法（CBT）对焦虑症的治疗效果，研究越来越关注对改变机制的理解。具体而言，治疗关系已被确定为治疗的一种潜在“活性成分”。对治疗关系的11个要素（联盟、协作、目标共识、团体凝聚力、同理心、积极关注、反馈、情感表达、结果期望、治疗可信度、联盟破裂-修复）对焦虑症CBT治疗结果的影响进行了系统综述。纳入了50项独特的研究，并对研究结果进行了定性综述和总结。结果显示，凝聚力-结果关系和期望-结果关系有一致且显著的证据。关于协作、同理心和联盟破裂-修复对结果的影响，有新出现的证据。然而，关于目标共识和可信度对结果的证据有限。值得注意的是，对联盟文献的综述显示，各研究之间存在大量不一致之处。未发现关于积极关注、反馈和情感表达的研究。总体而言，需要进一步研究以阐明治疗关系在焦虑症CBT中的作用。这些发现将有助于认知行为模型中治疗关系结构的概念整合，并有助于改善个体的治疗和治疗结果。
