The working alliance in manualized CBT for generalized anxiety disorder: Does it lead to change and does the effect vary depending on manual implementation flexibility?

Rubel, Julian A.; Hilpert, Peter; Wolfer, Christine; Held, Judith; Vîslă, Andreea; Flückiger, Christoph

doi:10.1037/ccp0000433

Cited by 19Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCounseling Practices and Supervision

The working alliance in manualized CBT for generalized anxiety disorder: Does it lead to change and does the effect vary depending on manual implementation flexibility?

Rubel, Julian A., Hilpert, Peter, Wolfer, Christine, Held, Judith, Vîslă, Andreea, Flückiger, Christoph·2019·Journal of Consulting and Clinical Psychology

DOI 10.1037/ccp0000433

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Abstract

OBJECTIVE: The investigation of session-to-session effects of working alliance on symptoms and coping experiences in patients diagnosed with generalized anxiety disorder. In addition, investigating these effects dependent on whether therapists are primed to work with patients strength (resource priming) or to adhere to the treatment manual (adherence priming). METHOD: Data was drawn from a randomized controlled trial in which 57 patients were randomly assigned to either the resource priming condition or the adherence priming condition. Within- and between patient associations were disentangled using dynamic structural equation modeling. RESULTS: The total score of the working alliance, as well as all its overlapping components (i.e., goal agreement, task consensus, bond) showed significant within-patient effects on next session coping experiences. More specifically, better alliance scores in one session were followed by more coping experiences in the subsequent session. With regard to anxiety symptoms, an association was found only with the working alliance total score as well as for the bonds component, but not for the goals and task components of the working alliance. The priming condition (resource priming vs. adherence priming) had no influence on the within-patient alliance-outcome association. Between-patient alliance associations were only present with coping experiences, but not with anxiety symptoms. CONCLUSION: The findings provide further empirical evidence for the hypothesis that the working alliance may be a robust facilitative factor for change in CBT treatments for generalized anxiety disorder, which evolves irrespective of the strictness with which therapists adhere to the treatment manual. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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The contribution of the components of the working alliance to change in generalized anxiety disorder symptoms, especially in cognitive behavioral therapy delivered by videoconference, has not yet been studied.
“The contribution of the components of the working alliance to change in GAD symptoms, especially in CBT delivered by VC, has not yet been studied.”
From The role of intolerance of uncertainty and working alliance in the outcome of cognitive behavioral therapy for generalized anxiety disorder delivered by videoconference: Mediation analysis (2021) · cites this paper as [31]

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Marcotte-Beaumier, G., Bouchard, S., Gosselin, P., Langlois, F., Belleville, G., Marchand, A., & Dugas, M. J. (2021) · JMIR Mental Health · doi:10.2196/24541 · Cited by 11 · see citing works

Authors: Rubel, J. A., Hilpert, P., Wolfer, C., Held, J., Vîslă, A., & Flückiger, C.
ORCID: Rubel, Julian A.
Hilpert, Peter
Wolfer, Christine
Held, Judith
Vîslă, Andreea
Flückiger, Christoph
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2019-11
Volume: 87
Issue: 11
Pages: 989-1002
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/ccp0000433
OpenAlex: W2976447022
Cited by: 19
References: 64
Citations by year: 2026: 1 · 2025: 4 · 2024: 2 · 2023: 6 · 2022: 3 · 2021: 2 · 2020: 1
FWCI: 1.75
Type: journal article
Language: en
Open access: closed
Locations: Journal of Consulting and Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
IRIS (submittedVersion)
SERVAL (Université de Lausanne) (submittedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders: Swiss National Science Foundation (SNSF PZ00P1_136937/1; PP00P1-163702)
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 › Social Psychology › Counseling Practices and Supervision
Keywords: therapeutic relationship, generalized anxiety disorder, cognitive behavioral therapy, coping experiences, anxiety symptoms, goal agreements, therapeutic bond, manualized psychotherapy
MeSH terms: Adaptation, Psychological, Adult, Anxiety Disorders, Female, Humans, Male, Middle Aged, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome, Guideline Adherence

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The working alliance in manualized CBT for generalized anxiety disorder: Does it lead to change and does the effect vary depending on manual implementation flexibility?

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