Patient alliance with the program predicts treatment outcomes whereas alliance with the therapist predicts adherence in internet-based therapy for panic disorder

Zalaznik, Dina; Strauss, Asher Y.; Halaj, Asala; Barzilay, Snir; Fradkin, Isaac; Katz, Benjamin A.; Ganor, Tal; Ebert, David Daniel; Andersson, Gerhard; Huppert, Jonathan D.

doi:10.1080/10503307.2021.1882712

Cited by 21 publications

(22 citation statements)

References 42 publications

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“…Therapist fidelity in ICBT is relatively consistent, as all written exchanges with the patient are recorded in the system, and the system, not the therapist, administers the main content of the treatment. Indeed, patient’s relationship to the program and content is what was found to predict symptom reduction in this sample (Zalaznik et al, in press). On average, therapists were described as warm and supportive, helping motivate the patient to engage in the modules.…”

Section: Methodsmentioning

confidence: 82%

“…On average, therapists were described as warm and supportive, helping motivate the patient to engage in the modules. Indeed, the relationship with the therapist predicted number of modules completed by the patient in this sample (Zalaznik et al, in press). Therapists helped clarify the CBT conceptualization of their panic when needed.…”

Section: Methodsmentioning

confidence: 92%

“…1This is an additional report from a study that was designed to ask a number of question of processes in ICBT for panic. In a previous report, we described the relationship between internet alliances and outcomes (Zalaznik et al, in press). Further reports regarding the main outcome as well as insight are currently in progress.…”

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confidence: 99%

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Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Zalaznik¹,

Strauss²,

Halaj³

et al. 2022

Journal of Counseling Psychology

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The purpose of this study was to examine whether anxious and avoidant attachment styles improve during guided internet-based cognitive behavioral treatment (ICBT) for panic disorder, and if so, to identify potential theoretically driven mechanisms related to the change. We examined changes in anxious and avoidant attachment and their time-lagged (1 week), longitudinal relationship with panic-related constructs in patients participating in ICBT (n = 79) in an open trial. Anxious attachment scores improved significantly with a medium effect during ICBT, d = 0.76 [0.45, 1.08]. According to benchmark analyses, changes were similar to the magnitude of change in face-to-face CBT and final scores to values of a nonclinical sample. Additionally, similar to findings in face-to-face CBT for panic disorder, longitudinal time analyses revealed that anxiety sensitivity scores predicted later improvement in anxious attachment scores, but not vice versa. Counter to our hypothesis, avoidant attachment did not significantly change during treatment, d = 0.15 [0.02, 0.46]; however, pretreatment level of avoidant attachment in ICBT was similar to the nonclinical sample. Also counter to our hypotheses, agoraphobic avoidant behaviors when alone did not predict changes in anxious attachment. These results suggest that anxious attachment can improve in ICBT for panic disorder even though the focus of the treatment is not on interpersonal relationships. These changes appear to follow changes in anxiety sensitivity. Public Significance StatementResults of this study suggest that anxious attachment improves following an internet-based intervention for panic disorder with minimal therapist contact (ICBT). This improvement appears to follow changes in anxiety sensitivity, or fear of one's bodily sensations, which are likely facilitated by self-driven techniques of cognitive restructuring and exposure. Thus, interpersonal factors can improve in psychotherapeutic interventions even when the involvement of the therapist is limited and the focus is on cognitive and behavioral change.

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Section: Methodsmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 92%

See 1 more Smart Citation

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Zalaznik¹,

Strauss²,

Halaj³

et al. 2022

Journal of Counseling Psychology

Self Cite

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“…These factors have been previously recognised as important in facilitating improvements in self-guided interventions (Andersson & Titov, 2014 ; Dear et al, 2016 ). Recent research suggests that “alliance with the program” is predictive of outcomes in ICBT (Zalaznik et al, 2021 ) and thus perhaps it was high alliance with the program in both the self-directed and team-guided groups that accounts for lack of differences between groups.…”

Section: Discussionmentioning

confidence: 99%

Internet-delivered cognitive behaviour therapy for chronic health conditions: self-guided versus team-guided

et al. 2022

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There is growing interest in offering Internet-delivered cognitive behaviour therapy (ICBT) to individuals with chronic health conditions, with this process often being guided by a single clinician. Due to lack of full time personnel, it is sometimes necessary to have multiple clinicians offer guidance or for no guidance to be offered. In this randomized trial, we compared team-guided ICBT (n = 90) to self-guided ICBT (n = 88). Participants completed measures at pre-, post-, and 3-months post-ICBT. Both groups showed similar rates of treatment completion and large improvements on depression and anxiety at post-treatment and follow-up. Unexpectedly, more participants in the self-guided versus team-guided condition showed clinically significant improvement on depression at post-treatment (76.5% vs 49.2%) and follow-up (70% vs 45.6%). Thus, team-guided ICBT may not provide significant benefits compared to self-guided ICBT. However, it may be an alternative approach to consider among a population of high risk individuals that wants or requires closer monitoring of symptoms.Trail registration TRN: NCT03500237; Date: April 18, 2018.

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“…Despite an extensive search for studies in this area, we were unable to find an adequate explanation for how a therapeutic protocol can be more effective than the relationship with the facilitator of the therapeutic group. A possible direction for the findings obtained in the present study is obtained from a recent study that examined relationships between various aspects of therapeutic alliance with treatment outcome, adherence, and attrition in Internet-delivered cognitive behavioral therapy (ICBT) for panic disorder with a newly developed self-report alliance measure [89]. Results indicate that the patient experience of the alliance in ICBT includes two aspects, each uniquely contributing to the outcome; patient connection to the program is related to the symptom outcome, whereas the dyadic relationship with the therapist serves as the glue to allow the treatment to hold.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Cognitive Behavioral Group Therapy on Children’s Self-Esteem

Epel

Zohar²,

Artom

et al. 2021

Children

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(1) Background: Self-esteem plays an important role in developing emotional resilience and wellbeing in children. Yet, there has been little related research on Cognitive Behavioral Group Therapy on this topic. Our aims were to assess the effect of the Child Self-Esteem CBT (CSE-CBT) protocol on children’s self-esteem in grades five and six; to assess the effect of the CSE-CBT protocol on the therapeutic process; and to explore the feasibility of delivering the CSE-CBT protocol in a school setting. (2) Methods: Eighty elementary school children in grades five and six, divided into four intervention and four control groups, attended 12 structured sessions using the CSE-CBT protocol, led by specially trained teachers. The children completed questionnaires to assess their self-esteem at the beginning and at the end of the study, and answered weekly questionnaires that assessed therapeutic process. Hierarchical linear modeling was used to analyze the data. (3) Results: The CSE-CBT protocol had a significant effect on improving children’s self-esteem over the course of the study, regardless of the children’s working alliance with the teacher leading the group. (4) Conclusions: The findings suggest that the CSE-CBT protocol has the potential to benefit children’s self-esteem and indicate that school teachers can be trained to administer the CBT-protocol.

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Patient alliance with the program predicts treatment outcomes whereas alliance with the therapist predicts adherence in internet-based therapy for panic disorder

Cited by 21 publications

References 42 publications

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

Internet-delivered cognitive behaviour therapy for chronic health conditions: self-guided versus team-guided

The Effect of Cognitive Behavioral Group Therapy on Children’s Self-Esteem

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