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A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders
Open accessAbstract
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
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“In a meta-analysis, Graves et al. (2017) have found that when treating adults with eating disorders using CBT-ED, the therapeutic alliance does not drive change in behaviors. Instead, early change in behaviors drives a better alliance later in therapy.”
From To deliver or not to deliver cognitive behavioral therapy for eating disorders: Replication and extension of our understanding of why therapists fail to do what they should do (2018) · cites this paper as Graves et al. (2017)
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Metadata
- Authors
- Graves, T. A., Tabri, N., Thompson‐Brenner, H., Franko, D. L., Eddy, K. T., Bourion‐Bedes, S., Brown, A., Constantino, M. J., Flückiger, C., Forsberg, S., Isserlin, L., Couturier, J., Paulson Karlsson, G., Mander, J., Teufel, M., Mitchell, J. E., Crosby, R. D., Prestano, C., Satir, D. A., Simpson, S., Sly, R., Lacey, J. H., Stiles‐Shields, C., Tasca, G. A., Waller, G., Zaitsoff, S. L., Rienecke, R., Le Grange, D., & Thomas, J. J.
- Affiliations
- Harvard University (US)
- Centre Hospitalier Lorquin Lorquin France
- South London and Maudsley NHS Foundation Trust (GB)
- University of Massachusetts Amherst (US)
- University of Bern (CH)
- Stanford Medicine (US)
- University of Ottawa (CA)
- McMaster Children's Hospital (CA)
- Anorexia‐Bulimia Eating Disorder Unit, The Sahlgrenska University Hospital Gothenburg Sweden
- Heidelberg University (DE)
- University of Duisburg-Essen (DE)
- University of North Dakota (US)
- University Niccolò Cusano (IT)
- University of Colorado Denver (US)
- University of South Australia (AU)
- University of East Anglia (GB)
- University of London (GB)
- Northwestern University (US)
- University of Sheffield (GB)
- Simon Fraser University (CA)
- University of Michigan (US)
- Department of Psychiatry University of California San Francisco California United States
- Corresponding author
- Thomas, Jennifer J.
- ORCID
- Tabri, Nassim
- Thompson‐Brenner, Heather
- Franko, Debra L.
- Eddy, Kamryn T.
- Brown, Amy
- Constantino, Michael J.
- Flückiger, Christoph
- Forsberg, Sarah
- Isserlin, Leanna
- Couturier, Jennifer
- Mander, Johannes
- Teufel, Martin
- Mitchell, James E.
- Crosby, Ross D.
- Prestano, Claudia
- Simpson, Susan
- Lacey, J. Hubert
- Stiles‐Shields, Colleen
- Tasca, Giorgio A.
- Waller, Glenn
- Zaitsoff, Shannon L.
- Rienecke, Renee
- Thomas, Jennifer J.
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2017-02-02
- Volume
- 50
- Issue
- 4
- Pages
- 323-340
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2584882068
- Cited by
- 196
- References
- 73
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 32 · 2023: 17 · 2022: 29 · 2021: 19 · 2020: 20 · 2019: 19 · 2018: 10 · 2017: 7
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- Carleton University's Institutional Repository (MacOdrum Library, Carleton University) (submittedVersion, other-oa)
- Deep Blue (University of Michigan) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- therapeutic relationship, eating disorders, treatment outcomes, psychosocial interventions, behavior therapy, patient age, moderators of treatment outcome
- MeSH terms
- Adult, Feeding and Eating Disorders, Cooperative Behavior, Female, Humans, Male, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome
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