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The alliance mediates outcome in cognitive–behavioral therapy for social anxiety disorder, but not in attention bias modification
Psychotherapy Research ( IF 4.117 ) Pub Date : 2020-10-28 , DOI: 10.1080/10503307.2020.1836423
Yogev Kivity , Asher Y. Strauss 1 , Jonathan Elizur 1 , Michal Weiss 1 , Lior Cohen 1 , Jonathan D. Huppert 1
Affiliation  

Abstract

Objective: The aim of the current study was to examine changes in the therapeutic alliance and its role as a mediator of treatment outcome in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). Method: Patients were randomized to 16–20 sessions of CBT (n = 33) or 8 sessions of ABM (n = 17). Patient-rated alliance and self-reported social anxiety were measured weekly and evaluator-rated social anxiety was measured monthly. Results: Early alliance predicted greater subsequent anxiety reduction in CBT but not in ABM. The alliance increased and weekly improvements in alliance predicted weekly contemporaneous and subsequent decreases in anxiety only in CBT. Decreases in anxiety did not predict subsequent improvements in alliance. Both treatments were effective in reducing anxiety, but treatment effects were mediated by stronger early alliance and stronger cross-lagged effects of alliance on outcome in CBT compared to ABM. Conclusions: The results highlight the importance of the alliance in CBT for SAD. Further studies should examine the role of alliance alongside additional mediators to better understand differential mechanisms in CBT and ABM.



中文翻译:

联盟在社交焦虑症的认知行为疗法中介导结果,但在注意力偏差改变中不介导结果。

摘要

目的:本研究的目的是研究与注意偏倚修正(ABM)相比,治疗联盟的变化及其在认知行为疗法(CBT)中对社交焦虑症(SAD)的治疗结果的介导作用。方法:将患者随机分为CBT 16-20疗程(n = 33)或ABM 8疗程(n = 17)。每周评估一次患者评分的联盟和自我报告的社交焦虑,每月评估一次评估者评分的社交焦虑。结果:早期的联盟预测,随后的CBT减轻会更大,而ABM则没有。联盟增加,而联盟的每周改善仅在CBT中预测每周同期和随后的焦虑降低。焦虑的减少并未预示着联盟的进一步改善。两种疗法均能有效减轻焦虑,但与ABM相比,治疗效果是由更强的早期同盟和更同盟对CBT结局的交叉滞后效应介导的。结论:结果突显了CBT中的联盟对于SAD的重要性。进一步的研究应与其他调解人一起探讨联盟的作用,以更好地理解CBT和ABM中的差异机制。

更新日期:2020-10-28
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