The working alliance in manualized CBT for generalized anxiety disorder Does it lead to change and does the effect vary depending on manual implementation flexibility?

Rubel, Julian A., Hilpert, Peter, Wolfer, Christine, Held, Judith, Vîslă, Andreea and Flückiger, Christoph (2019) The working alliance in manualized CBT for generalized anxiety disorder Does it lead to change and does the effect vary depending on manual implementation flexibility? Journal of Consulting and Clinical Psychology.

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Abstract

Objective: The investigation of session-to-session effects of working alliance on symptoms and coping experiences in patients diagnosed with GAD. Additionally, investigating these effects dependent on whether therapists are primed to work with patients strength (resource priming) or to adhere to the treatment manual (adherence priming).

Method: Data was drawn from a randomized controlled trial in which 57 patient were randomly assigned to either the resource priming condition or the adherence priming condition. Within- and between patient associations were disentangled using dynamic structural equation modeling.

Results: The total score of the working alliance as well as all its overlapping components (i.e., goal agreement, task consensus, bond) showed significant within-patient effects on next session coping experiences. More specifically, better alliance scores in one session were followed by more coping experiences in the subsequent session. With regard to anxiety symptoms, an association was found only with the working alliance total score as well as for the bonds component, but not for the goals and task components of the working alliance. The priming condition (resource priming vs adherence priming) had no influence on the within-patient alliance-outcome association. Between-patient alliance associations were only present with coping experiences, but not with anxiety symptoms.

Conclusion: The findings provide further empirical evidence for the hypothesis that the working alliance may be a robust facilitative factor for change in CBT treatments for GAD which evolves irrespective of the strictness with which therapists adhere to the treatment manual.

Item Type:	Article
Divisions :	Faculty of Health and Medical Sciences > School of Psychology
Authors :	Name Email ORCID Rubel, Julian A. Hilpert, Peter p.hilpert@surrey.ac.uk Wolfer, Christine Held, Judith Vîslă, Andreea Flückiger, Christoph
Date :	2019
Copyright Disclaimer :	© 2019 American Psychological Association. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. Please do not copy or cite without author's permission. The final article is available, upon publication, at: [ARTICLE DOI]
Uncontrolled Keywords :	Working alliance; Adherence; Generalized anxiety disorder; Within-patient associations; Dynamic structural equation modeling
Related URLs :	Publisher
Depositing User :	Clive Harris
Date Deposited :	01 Aug 2019 13:14
Last Modified :	16 Sep 2019 13:19
URI:	http://epubs.surrey.ac.uk/id/eprint/852341

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