Therapist effects and the outcome–alliance correlation in cognitive behavioral therapy for panic disorder with agoraphobia
Section snippets
The multicenter collaborative study for the treatment of panic disorder (MCSTPD)
For full details of the trial and the previous therapist effects analysis see Barlow et al. (2000) and Huppert et al. (2001). In the current analyses, all CBT groups (e.g., CBT only and CBT combined with imipramine/placebo pill) were combined and analyzed together.
Participants. Of the 205 patients diagnosed with primary panic disorder with or without agoraphobia that were randomized to CBT, 183 patients (70 men, 113 women) had sufficient data to be included in our analyses.
Therapists. Fourteen
Effect size of treatment in the LTS
The effect size of treatment on PDSS-IE was calculated as pre-to-post Cohen's d and was found to be large, t(255) = 21.83, p < 0.001, d = 1.36, 95% CI [1.19, 1.53].
Effect sizes of treatment on PDSS-SR and ASI were calculated as the percent of variance which was explained by the addition of time as a predictor to a model without time as a predictor at level 1. Using this approach, we found that the effect sizes of treatment were large for both PDSS-SR, t(309) = −18.95, p < 0.001, ES = 0.40 and
Discussion
The present study examined therapist effects on outcome and attrition in CBT for PDA and the therapeutic alliance at the patient and therapist levels as a predictor of change in therapy. In a large-scale clinical trial (LTS), we found that the patient's contribution to the therapeutic alliance, as perceived by patients themselves, usually predicted outcome and attrition, both early (session 3) and late (session 9) in the course of treatment, even after controlling for early symptom improvement.
Acknowledgments
The results of this study were presented in part at the Association for Behavioral and Cognitive Therapies (ABCT) 45th Annual Convention, Toronto, Canada. Supported by the National Institute of Mental Health with grants: R01 MH45963, MH45964, MH45965, and MH45966. The authors would like to thank Avraham N. Kluger for his helpful comments on an earlier version of this paper.
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2022, Comprehensive Clinical Psychology, Second EditionElements of the therapeutic relationship in CBT for anxiety disorders: A systematic review
2020, Journal of Anxiety DisordersA systematic review of therapist effects: A critical narrative update and refinement to Baldwin and Imel's (2013) review
2019, Clinical Psychology ReviewCitation Excerpt :Inclusion of any of these studies may have impacted on the results. For example, Huppert et al. (2014) found small effects in the context of a trial, which would likely have reduced the therapist effect reported for trial data given the small number of studies reported. After completing the review and at a stage too late for inclusion in the tables, we found a study by Berglar et al. (2016) that was relevant, within the search time frame, and only listed in Web of Science but which, inexplicably, did not get identified by the search terms and, therefore, did not appear in the original pool of 1566 references.
What matters more? Common or specific factors in cognitive behavioral therapy for OCD: Therapeutic alliance and expectations as predictors of treatment outcome
2018, Behaviour Research and TherapyCitation Excerpt :For example, Wampold and Imel have stated that “Therapist effects generally exceed treatment effects, which at most account for 1% of the variability in outcomes” (Wampold & Imel, 2015, p. 176). However, some research has reported little therapist variance and significant patient variance in manualized protocols (e.g., in CBT for panic disorder; Huppert et al., 2014). Few studies have examined the relative contribution of common vs. specific factors in a given study (that is, they tend to either examine the role of common factors or specific factors).
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The first and second authors contributed equally to this manuscript.