The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders
Abstract
The present study explored the impact of early symptom change (cognitive and behavioural) and the early therapeutic alliance on treatment outcome in cognitive-behavioural therapy (CBT) for the eating disorders. Participants were 94 adults with diagnosed eating disorders who completed a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment, following the 6th session and at the end of treatment. They also completed a measure of therapeutic alliance following the 6th session. Greater early reduction in dietary restraint and eating concerns, and smaller levels of change in shape concern, significantly predicted later reduction in global eating pathology. The early therapeutic alliance was strong across the three domains of tasks, goals and bond. Early symptom reduction was a stronger predictor of later reduction in eating pathology than early therapeutic alliance. The early therapeutic alliance did not mediate the relationship between early symptom reduction and later reduction in global eating pathology. Instead, greater early symptom reduction predicted a strong early therapeutic alliance. Early clinical change was the strongest predictor of treatment outcome and this also facilitated the development of a strong early alliance. Clinicians should be encouraged to deliver all aspects of evidence-based CBT, including behavioural change. The findings suggest that this will have a positive impact on both the early therapeutic alliance and later change in eating pathology.
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Greater early symptom reduction has been shown to predict a strong therapeutic alliance (Turner et al., 2015).
“greater early symptom reduction has been shown to predict a strong therapeutic alliance (Turner et al., 2015)”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Turner et al., 2015
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- Authors
- Turner, H., Bryant-Waugh, R., & Marshall, E.
- Affiliations
- Southern Health NHS Foundation Trust (GB)
- Corresponding author
- Turner, Hannah
- ORCID
- Turner, Hannah
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 73
- Pages
- 165-169
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1119862419
- Cited by
- 45
- References
- 33
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 3 · 2021: 7 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 6 · 2016: 4 · 2015: 3
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- 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
- eating disorders, cognitive behavioral therapy, therapeutic relationship, treatment outcomes, dietary restraint, eating concerns, shape concern, eating pathology, behavior change
- MeSH terms
- Adult, Feeding and Eating Disorders, Cooperative Behavior, Female, Humans, Male, Middle Aged, Outpatients, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome
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