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Cited by 64Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults

Haug, Thomas, Nordgreen, Tine, Öst, Lars-Göran, Tangen, Tone, Kvale, Gerd, Hovland, Ole Johan, Heiervang, Einar R., Havik, Odd E.·2016·Behaviour Research and Therapy
DOI 10.1016/j.brat.2015.12.004
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Abstract

Objective The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD).Method Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses.Results Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout.Conclusion The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.

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Authors
Haug, T., Nordgreen, T., Öst, L.-G., Tangen, T., Kvale, G., Hovland, O. J., Heiervang, E. R., & Havik, O. E.
Affiliations
  • Haukeland University Hospital (NO)
  • Stockholm University (SE)
  • University of Oslo (NO)
Corresponding author
Haug, Thomas
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2016-02
Volume
77
Pages
40-51
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2015.12.004
OpenAlex
W2191906721
Cited by
64
References
90
Citations by year
2025: 8 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 10 · 2020: 13 · 2019: 2 · 2018: 10 · 2017: 6 · 2016: 3
FWCI
7.85
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
Funders
Western Norway Regional Health Authority (911366, 911253)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
therapeutic relationship, therapist competence, therapist adherence, cognitive behavioral therapy, social anxiety disorder, panic disorder, treatment outcomes, treatment discontinuation, prognostic factors
MeSH terms
Phobia, Social, Adult, Female, Forecasting, Health Personnel, Humans, Male, Middle Aged, Patient Compliance, Professional Competence, Professional-Patient Relations, Cognitive Behavioral Therapy, Panic Disorder, Treatment Outcome, Self Report

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