Working alliance does not mediate the relation between outcome expectancy and symptom improvement following cognitive behavioural therapy for social anxiety disorder
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) Readers will consider the role of common factors in treatment for…
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Another study did not find evidence for a direct link between therapeutic alliance and response rates in VRET.
“By contrast, another study (Draheim and Anderson, 2019) did not find evidence for a direct link between therapeutic alliance and response rates in VRET.”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Draheim and Anderson, 2019
VRET allows for the development of a therapeutic alliance of comparable strength to exposure in vivo.
“Directly compared, VRET seems to allow for the development of a therapeutic alliance of comparable strength to exposure in vivo (Ngai, 2012; Draheim and Anderson, 2019).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Draheim and Anderson, 2019
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- Authors
- Draheim, A. A., & Anderson, P. L.
- Affiliations
- Georgia State University (US)
- Corresponding author
- Anderson, Page L.
- Venue
- The Cognitive Behaviour Therapist
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019
- Volume
- 12
- ISSN
- 1754-470X (ISSN-L)
- OpenAlex
- W2972536834
- Cited by
- 8
- References
- 35
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 3 · 2022: 1 · 2020: 1
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Cognitive Behaviour Therapist (publishedVersion)
- 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, outcome expectations, social anxiety disorder, cognitive behavioral therapy, virtual reality exposure therapy, symptom improvement, mediation, common factors, Bayesian analysis
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