Dynamic relationships of therapist alliance and group cohesion in transdiagnostic group CBT for anxiety disorders.

Abstract

Objective Little is known about the temporal variability of the alliance-symptom change and cohesion-symptom change relationships over the course of group therapy. These questions were examined in a sample of 373 clients receiving a transdiagnostic cognitive behavior therapy (tCBT), which culled the principle research-supported mechanisms of change for anxiety disorders. Method We examined relationships between the client versions of the Working Alliance Inventory and Group Cohesion Scale in predicting subsequent symptom change, as assessed by the state scale of the State-Trait Anxiety Inventory. Results Alliance and cohesion were significant predictors of next session anxiety scores. The alliance was consistently associated with anxiety symptoms (rs = −.152 to −.198, ps < .05), but cohesion only showed significant relationships with anxiety symptoms at sessions 8 and 10 (Session 8, r = −.233, p = .020, and 10, r = −.236, p = .027). Alliance-anxiety relations remained constant, whereas cohesion-anxiety relations substantially increased from earlier to later sessions. Discussion Differences that were obtained in the relation of alliance and cohesion with anxiety symptoms suggests that these processes have different roles within group tCBT. If replicated, the present findings would suggest that the dynamic relationships between alliance and cohesion and symptoms within group CBT for anxiety disorders have been an important omission in process-outcome studies.

Does group cohesion foster self-directed learning for medical students? A longitudinal study

“…These results are different from previous studies. Medical students at Dalhousie University indicated no difference in SDLRS scores when measured longitudinally over a one-year period after making changes to the curriculum [26]; on the other hand, there was a significant decrease at the end of the first year after admission [14]. A study conducted on medical students at the University of Toronto Family of Medicine, which administered three instruments measuring SDL (e.g.…”

“…Baskett [13] identified workplace factors that improve SDL and found that effective communication systems, an environment of trust and mutual respect, and collaboration among organization members were all important factors for enhancing SDL. Previous studies have shown that self-directed learning involves interaction with peers and teachers to exchange information [2,14].…”

“…Peers are significant in medical school life. Group cohesion is one of the most widely used constructs to measure relationships in clinical and empirical literature [14]. While there are several definitions of group cohesion, it is generally identified as a sense of bonding or working together towards common goals, mutual acceptance, and identification and affiliation with a group [14,15].…”

Case conceptualization research in cognitive behavior therapy: A state of the science review

“…It would also be an interesting empirical question to determine the relative clinical utility of different formats of case conceptualizations, and thus it would be useful to ensure inclusion of commonly used formats of case conceptualization in research designs and describe this explicitly in the study method. In this regard, comparison of CBT case conceptualization formats with transdiagnostic conceptualization approaches would also offer interesting avenues for empirical investigation (Barlow et al., ; Dudley, Kuyken, & Padesky, ; Norton & Kazantzis, ).…”

“…and describe this explicitly in the study method. In this regard, comparison of CBT case conceptualization formats with transdiagnostic conceptualization approaches would also offer interesting avenues for empirical investigation (Barlow et al, 2011;Norton & Kazantzis, 2016).…”