The role of therapist and patient in‐session behavior for treatment outcome in exposure‐based cognitive behavioral therapy for panic disorder with agoraphobia

Maiwald, Lisa Marie; Junga, Yvonne M.; Lang, Thomas; Montini, Romina; Witthöft, Michael; Heider, Jens; Schröder, Annette; Weck, Florian

doi:10.1002/jclp.22738

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…With regard to the therapeutic alliance, our results suggest that it is not a significant predictor of symptom change in a one-session exposure treatment for SP. Our findings are in line with other studies on anxiety disorders that measured the therapeutic alliance and found no significant allianceoutcome relationship (e.g., Maiwald et al, 2019). It might be that the alliance is not equally important in the treatment of this diagnostic group as it is for other mental disorders.…”

Section: Discussionsupporting

confidence: 92%

Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia

et al. 2022

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Background Exposure-based treatments have demonstrated some of the largest effect sizes in the treatment of specific phobias (SP). There are different ways of delivering exposure such as Augmented Reality Exposure which has become an interesting alternative to In Vivo Exposure for treating SP. The present study aimed to investigate the therapeutic alliance and treatment expectations as possible predictors of treatment outcomes in these two exposure treatment conditions. Methods Participants were 63 adults who met diagnostic criteria for the diagnosis of a SP of cockroaches or spiders (animal subtype). Patients were randomized to receive a one-session treatment of either In Vivo Exposure (N = 31) or Augmented Reality Exposure (N = 32). The assessment protocol included diagnostic, as well as primary-, and secondary outcome measures. Materials included the Behavioral Avoidance Test for measuring symptoms and outcomes, the Expectations and Satisfaction Questionnaire, and the Working Alliance Inventory. We ran multilevel analyses for the study of predictors controlling for the treatment effect conditions. Results Results showed a significant effect of expectations on treatment outcomes (specifically avoidance and beliefs scores). The therapeutic alliance did not have a significant effect on treatment outcome. Patients reduced their symptoms of phobia. Conclusion These results empirically support treatment expectations as a relevant predictor of change in exposure treatments for SP.

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Section: Discussionsupporting

confidence: 92%

Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia

et al. 2022

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“…An approach to these questions can be helped by recent findings that, although there are demonstrable differences between therapists in their levels of adherence, there are also sizeable differences within each therapist's caseload, as reported by Baldwin and Imel (2013), Boswell et al (2013), Imel et al (2011), andMaiwald et al (2019), for example. As these researchers have noted, the fact that therapists tend to vary in adherence across clients points to the mutual, interactive influence of the dyad on the therapist's choice of interventions, as the responsiveness model predicts.…”

Section: Considering the Issue Of Responsiveness In Specified Treatme...mentioning

confidence: 99%

Responsiveness, the relationship, and the working alliance in psychotherapy.

Hatcher¹

2021

The Responsive Psychotherapist: Attuning to Clients in the Moment.

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“…With regard to the aforementioned clinical microskills, there are almost as many MLM studies that could not find a significant association between clinical microskills and treatment outcome (e.g., Bisseling et al, 2019; Boswell et al, 2013; Hogue et al, 2008; Huijbers et al, 2017; Maiwald et al, 2019; Southam-Gerow et al, 2021). Moreover, in a meta-analytic review, Webb et al (2010) demonstrated that the association between clinical microskills and outcome is quite small and not significantly different from zero.…”

mentioning

confidence: 99%

Within and between associations of clinical microskills and correct application of techniques/strategies: A longitudinal multilevel approach.

Uhl¹,

Schaffrath²,

Schwartz³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: The therapist effect has been demonstrated in various studies. However, studies on putative therapist characteristics show heterogeneous results. Although the majority of studies have solely examined effects between therapists, a growing interest in effects within therapists has emerged. However, it remains unclear whether therapist characteristics are rather a state-like than a trait-like phenomenon. The main aim of the present study is to test whether clinical microskills as well as correct application of techniques and strategies (both between and within therapists) predict across-session change of symptom severity in a large naturalistic data set. Method: The results are based on 398 patients and 48 therapists who treated 5–17 patients each. Clinical microskills and correct application of techniques/strategies were rated using the Inventory of Therapeutic Interventions and Skills, and symptom severity was assessed with the Hopkins Symptom Checklist-11. Results: Results demonstrated significant within- and between-therapist variability in clinical microskills and correct application of techniques/strategies, and no change over the course of treatment in both variables. Moreover, correct application of techniques/strategies was significantly associated with symptom improvement within, but not between therapists. In addition, higher treatment difficulty as well as an interaction between treatment difficulty and correct application of techniques/strategies were significantly associated with symptom improvement. Clinical microskills were neither predictive of symptom improvement within nor between therapists. Conclusions: These results provide initial evidence that not the therapist’s average correct application of techniques/strategies is important, but rather how correctly they use a technique with a specific patient.

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The role of therapist and patient in‐session behavior for treatment outcome in exposure‐based cognitive behavioral therapy for panic disorder with agoraphobia

Cited by 7 publications

References 30 publications

Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia

Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia

Responsiveness, the relationship, and the working alliance in psychotherapy.

Within and between associations of clinical microskills and correct application of techniques/strategies: A longitudinal multilevel approach.

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