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Working alliance does not mediate the relation between outcome expectancy and symptom improvement following cognitive behavioural therapy for social anxiety disorder

Published online by Cambridge University Press:  09 September 2019

Amanda A. Draheim  and
Page L. Anderson Open the ORCID record for Page L. Anderson [Opens in a new window]
Amanda A. Draheim
Affiliation:
Georgia State University, Department of Psychology, Atlanta, GA, USA
Page L. Anderson*
Affiliation:
Georgia State University, Department of Psychology, Atlanta, GA, USA
*
*Corresponding author. Email: panderson@gsu.edu
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Abstract

A small body of research shows that the working alliance mediates the relation between outcome expectancy and treatment response, but this model has not been applied to the treatment of social anxiety disorder. The present study tests the hypothesis that the working alliance mediates the relation between outcome expectancy and symptom improvement within a randomized controlled trial testing the efficacy of virtual reality exposure therapy for social anxiety disorder. A sample of 54 individuals diagnosed with social anxiety disorder completed eight sessions of virtual reality exposure therapy or exposure group therapy. Participants completed standardized self-report measures of outcome expectancy at the first session, of the working alliance at each session, and three measures of social anxiety symptoms at pre- and post-treatment. The working alliance did not mediate the relation between outcome expectancy and symptom improvement across time points, dependent measures, and treatment type. Bayes factors were calculated for the relation between the working alliance and symptom reduction, while controlling for outcome expectancy and therapist effects. Results were inconclusive. These null findings are intriguing and urge further study of the mechanisms through which common factors relate to treatment response. Utilization of Bayesian analyses may help to clarify the nature of these relations.

Key learning aims

  1. (1) Readers will consider the role of common factors in treatment for social anxiety disorder.

  2. (2) Readers will learn about how different common factors may interact with each other.

  3. (3) Readers will be encouraged to consider how the therapeutic relationship may manifest in a unique manner in treatment for social anxiety.

Keywords

CBToutcome expectancysocial anxietyvirtual realityworking alliance
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e41
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Further reading

Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 751–760. doi: 10.1037/a0033559751 CrossRefGoogle ScholarPubMed
Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. Journal of Clinical Psychology, 67, 184–192. doi: 10.1002/jclp.20754 CrossRefGoogle ScholarPubMed
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55, 316–340. doi: 10.1037/pst0000172 CrossRefGoogle ScholarPubMed
Kazdin, A. E. (2005). Treatment outcomes, common factors, and continued neglect of mechanisms of change. Clinical Psychology: Science and Practice, 12, 184–188. doi: 10.1093/clipsy.bpi023 Google Scholar

References

Abouguendia, M., Joyce, A. S., Piper, W. E., & Ogrodniczuk, J. S. (2004). Alliance as a mediator of expectancy effects in short-term group psychotherapy. Group Dynamics: Theory, Research, and Practice, 8, 3–12. doi: 10.1037/1089-2699.8.1.3 CrossRefGoogle Scholar
Alden, L. E., & Taylor, C. T. (2004). Interpersonal processes in social phobia. Clinical Psychology Review, 24, 857–882. doi: 10.1016/j.cpr.2004.07.006 CrossRefGoogle ScholarPubMed
Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 751–760. doi: 10.1037/a0033559751 CrossRefGoogle ScholarPubMed
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., … & Carlbring, P. (2012). Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder. Behaviour Research and Therapy, 50, 544–550. doi: 10.1016/j.brat.2012.05.003 CrossRefGoogle ScholarPubMed
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi: 10.1037/0022-3514.51.6.1173 CrossRefGoogle ScholarPubMed
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252–260. doi: 10.1037/h0085885 CrossRefGoogle Scholar
Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257–260. doi: 10.1016/0005-7916(72)90045-6 CrossRefGoogle Scholar
Camacho, L. M., & Paulus, P. B. (1995). The role of social anxiousness in group brainstorming. Journal of Personality and Social Psychology, 68, 1071–1080. doi: 10.1037/0022-3514.68.6.1071 CrossRefGoogle Scholar
Constantino, M. J., Arnkoff, D. B., Glass, C. R., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. Journal of Clinical Psychology, 67, 184–192. doi: 10.1002/jclp.20754 CrossRefGoogle ScholarPubMed
Davila, J., & Beck, J. G. (2002). Is social anxiety associated with impairment in close relationships? A preliminary investigation. Behavior Therapy, 33, 427–446. doi: 10.1016/S0005-7894(02)80037-5 CrossRefGoogle Scholar
Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86. doi: 10.1016/S0005-7916(00)00012-4 CrossRefGoogle ScholarPubMed
Dienes, Z. (2014). Using Bayes to get the most out of non-significant results. Frontiers in Psychology, 5, 1–17. doi: 10.3389/fpsyg.2014.00781 CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1994). Structured Clinical Interview for Axis I DSM-IV Disorders – Research. New York, NY, USA: Biometrics Research Department.Google Scholar
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55, 316–340. doi: 10.1037/pst0000172 CrossRefGoogle ScholarPubMed
Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. doi: 10.1111/j.1467-9280.2007.01882 CrossRefGoogle ScholarPubMed
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY, USA: Guilford Press.Google Scholar
Hayes, S. A., Hope, D. A., VanDyke, M. M., & Heimberg, R. G. (2007). Working alliance for clients with social anxiety disorder: relationship with session helpfulness and within-session habituation. Cognitive Behaviour Therapy, 36, 34–42. doi: 10.1080/16506070600947624 CrossRefGoogle ScholarPubMed
Johansson, P., Høglend, P., & Hersoug, A. G. (2011). Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy. British Journal of Clinical Psychology, 50, 283–297. doi: 10.1348/014466510X517406 Google ScholarPubMed
Joyce, A. S., Ogrodniczuk, J. S., Piper, W. E., & McCallum, M. (2003). The alliance as mediator of expectancy effects in short-term individual therapy. Journal of Consulting and Clinical Psychology, 71, 672–679. doi: 10.1037/0022-006X.71.4.672 CrossRefGoogle ScholarPubMed
Kazdin, A. E. (2005). Treatment outcomes, common factors, and continued neglect of mechanisms of change. Clinical Psychology: Science and Practice, 12, 184–188. doi: 10.1093/clipsy.bpi023 Google Scholar
Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371–375. doi: 10.1177/0146167283093007 CrossRefGoogle Scholar
Liebowitz, M. R. (1987). Social phobia. Modern Problems in Pharmacopsychiatry, 22, 141–173. doi: 10.1159/000414022 CrossRefGoogle ScholarPubMed
Meyer, B., Pilkonis, P. A., Krupnick, J. L., Egan, M. K., Simmens, S. J., & Sotsky, S. M. (2002). Treatment expectancies, patient alliance, and outcome: further analyses from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 70, 1051–1055. doi: 10.1037//0022-006X.70.4.1051 CrossRefGoogle ScholarPubMed
Mörtberg, E. (2014). Working alliance in individual and group cognitive therapy for social anxiety disorder. Psychiatry Research, 220, 716–718. doi: 10.1016/j.psychres.2014.07.004 CrossRefGoogle ScholarPubMed
Muran, J. C., & Safran, J. D. (2002). A relational approach to psychotherapy. In Magnavita, J. J. (ed), Comprehensive Handbook of Psychotherapy: Psychodynamic/Object Relations, pp. 253–281. New York, NY, USA: John Wiley & Sons.Google Scholar
Natale, M., Entin, E., & Jaffe, J. (1979). Vocal interruptions in dyadic communication as a function of speech and social anxiety. Journal of Personality and Social Psychology, 37, 865–878. doi: 10.1037/0022-3514.37.6.865 CrossRefGoogle ScholarPubMed
Oddli, H. W., Nissen-Lie, H. A., & Halvorsen, M. S. (2016). Common therapeutic change principles as ‘sensitizing concepts’: a key perspective in psychotherapy integration and clinical research. Journal of Psychotherapy Integration, 26, 160–171. doi: 10.1037/int0000033 CrossRefGoogle Scholar
Parker, Z. J., Waller, G., Gonzalez Salas Duhne, P., & Dawson, J. (2018). The role of exposure in treatment of anxiety disorders: a meta-analysis. International Journal of Psychology and Psychological Therapy, 18, 111–141.Google Scholar
Paul, G. L. (1966). Insight vs Desensitization in Psychotherapy. Stanford, CA, USA: Stanford University Press.Google Scholar
Price, M., & Anderson, P. L. (2012). Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder. Psychotherapy, 49, 173–179. doi: 10.1037/a0024734 CrossRefGoogle ScholarPubMed
Rappaport, L. M., Moskowitz, D. S., & D’Antono, B. (2014). Naturalistic interpersonal behavior patterns differentiate depression and anxiety symptoms in the community. Journal of Counseling Psychology, 61, 253–263. doi: 10.1037/a0035625 CrossRefGoogle Scholar
Sauer-Zavala, S., Boswell, J. F., Bentley, K. H., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2018). Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: an investigation of mediation. Cognitive Therapy and Research, 42, 134–145. doi: 10.1007/s10608-017-9855-8 CrossRefGoogle ScholarPubMed
Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207–210. doi: 10.1037/1040-3590.1.3.207 CrossRefGoogle Scholar
Unnebrink, K., & Windeler, J. (2001). Intention-to-treat: methods for dealing with missing values in clinical trials of progressively deteriorating diseases. Statistics in Medicine, 20, 3931–3946. doi: 10.1002/sim.1149 CrossRefGoogle ScholarPubMed
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14, 270–277. doi: 10.1002/wps.20238 CrossRefGoogle ScholarPubMed
Woody, S. R., & Adessky, R. S. (2003). Therapeutic alliance, group cohesion, and homework compliance during cognitive-behavioral group treatment of social phobia. Behavior Therapy, 33, 5–27. doi: 10.1016/S0005-7894(02)80003-X CrossRefGoogle Scholar
Vȋslă, A., Constantino, M. J., Newkirk, K., Ogrodniczuk, J. S., & Söchting, I. (2018). The relation between outcome expectations, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy. Psychotherapy Research, 28, 446–456. doi: 10.1080/10503307.2016.1218089 CrossRefGoogle Scholar
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