The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder
<p><strong>Background:</strong><br /> Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.</p><br /> <p><strong...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Frontiers Media
2021
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| _version_ | 1826295856859447296 |
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| author | Beierl, E Murray, H Wiedemann, M Warnock-Parkes, E Wild, J Stott, R Grey, N Clark, DM Ehlers, A |
| author_facet | Beierl, E Murray, H Wiedemann, M Warnock-Parkes, E Wild, J Stott, R Grey, N Clark, DM Ehlers, A |
| author_sort | Beierl, E |
| collection | OXFORD |
| description | <p><strong>Background:</strong><br />
Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.</p><br />
<p><strong>Objective:</strong><br />
To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).</p><br />
<p><strong>Methods:</strong><br />
Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.</p><br />
<p><strong>Results:</strong><br />
Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.</p><br />
<p><strong>Conclusions:</strong><br />
Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.</p> |
| first_indexed | 2024-03-07T04:07:24Z |
| format | Journal article |
| id | oxford-uuid:c6a7a15d-59f5-43fa-be20-2fa8560a989b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T04:07:24Z |
| publishDate | 2021 |
| publisher | Frontiers Media |
| record_format | dspace |
| spelling | oxford-uuid:c6a7a15d-59f5-43fa-be20-2fa8560a989b2022-03-27T06:39:34ZThe relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorderJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:c6a7a15d-59f5-43fa-be20-2fa8560a989bEnglishSymplectic ElementsFrontiers Media2021Beierl, EMurray, HWiedemann, MWarnock-Parkes, EWild, JStott, RGrey, NClark, DMEhlers, A<p><strong>Background:</strong><br /> Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.</p><br /> <p><strong>Objective:</strong><br /> To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).</p><br /> <p><strong>Methods:</strong><br /> Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.</p><br /> <p><strong>Results:</strong><br /> Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.</p><br /> <p><strong>Conclusions:</strong><br /> Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.</p> |
| spellingShingle | Beierl, E Murray, H Wiedemann, M Warnock-Parkes, E Wild, J Stott, R Grey, N Clark, DM Ehlers, A The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title | The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title_full | The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title_fullStr | The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title_full_unstemmed | The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title_short | The relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
| title_sort | relationship between working alliance and symptom improvement in cognitive therapy for posttraumatic stress disorder |
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