Bose Deepika, Pettit Jeremy W, Silk Jennifer S, Ladouceur Cecile D, Olino Thomas M, Forbes Erika E, Siegle Greg J, Dahl Ronald E, Kendall Phillip C, Ryan Neal D, McMakin Dana L
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine.
Department of Psychology and Center for Children and Families, Florida International University.
J Clin Child Adolesc Psychol. 2023 Oct 5:1-11. doi: 10.1080/15374416.2023.2261547.
Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths ( = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety.
We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time.
Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance.
Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.
青少年焦虑症文献中已记载了治疗联盟与治疗结果（如青少年症状严重程度）之间的正向关联；然而，对于早期联盟在何种情况下有助于青少年获得积极治疗结果，我们却知之甚少。本研究考察了参与一项随机临床试验的青少年（n = 135；55.6%为女性）中治疗联盟、治疗课程出席率与治疗结果之间的关系，该试验旨在测试认知行为疗法或以人为中心疗法对焦虑症的疗效。
我们评估了一个概念模型，其中：（1）早期联盟通过提高治疗课程出席率间接促成积极的治疗结果；（2）联盟与治疗结果的关联因干预类型而异，与以人为中心疗法相比，认知行为疗法中的关联更强；（3）联盟与治疗结果的关联在不同的结果测量时间点有所不同，早期联盟对治疗结果的影响会随着时间衰减。
与假设相反，早期联盟的治疗师评分预示着治疗后青少年自评的焦虑症状严重程度更高（即治疗结果更差）。治疗课程出席率预示着青少年自评的积极治疗结果，不过早期联盟并未通过治疗课程出席率对治疗结果产生间接影响。
结果表明，提高治疗课程出席率对改善治疗结果很重要，且不支持将早期联盟作为治疗结果的预测指标。
