Symposia
Treatment - CBT
Martina Fruhbauerova, M.S.
Doctoral Student
University Of Kentucky
Lexington, Kentucky
Matthew W. Southward, Ph.D.
Research Assistant professor
University of Kentucky
Lexington, Kentucky
Douglas R. Terrill, PhD
Clinical Psychology Doctoral Student
Univeristy of Kentuckyl
Lexington, Kentucky
Stephen A. Semcho, M.A.
Clinical Psychology Doctoral Student
University of Kentucky
Lexington, Kentucky
Nicole E. Stumpp, M.S.
Clinical Psychology Doctoral Student
University of Kentucky
lexington, Kentucky
Shannon Sauer-Zavala, Ph.D.
Assistant Professor
University of Kentucky
Lexington, Kentucky
Background. The therapeutic alliance (Zilcha-Mano et al., 2016) and the use of therapeutic skills (Southward et al., 2021) have been hypothesized to contribute to symptom change in cognitive-behavioral treatments (CBTs) for anxiety and mood disorders. Stronger alliances are associated with more positive treatment outcomes across a range of psychotherapies and conditions (Baier et al., 2020; Flückiger et al., 2018; Zilcha-Mano, 2019). Some researchers have argued that the alliance plays an active role in promoting symptom reduction, either as a mechanism of change or by facilitating other mechanistic processes (Siev et al., 2009; Zilcha-Mano et al., 2016). Other researchers have demonstrated that adaptive skill use is an important mechanism driving symptom reduction in CBT for anxiety and mood disorders (Southward et al., 2021). Skill use is a potentially important mechanism by which symptom changes occur in treatment, and it is possible that experiencing a stronger alliance motivates more skillful application of therapeutic strategies, leading to symptom reductions. However, no research has examined the temporal relation between therapeutic alliance, skill use, and the impact of this interaction on symptom improvement.
Method. To test this question, participants (N = 70; Mage = 33.74, 67% female, 74% white) engaged in six sessions of core Unified Protocol (UP; Barlow et al., 2011) modules during the first-stage randomization of a sequential multiple assignment randomized trial (SMART). They completed measures of UP skill use (i.e., skill knowledge, frequency, quality, and effectiveness; Southward & Sauer-Zavala, 2021), anxiety (OASIS; Norman et al., 2006), and depression (ODSIS; Bentley et al., 2014) symptoms before each session and a measure of the therapeutic alliance (WAI; Hatcher & Gillaspy, 2006) after each session. We conducted two within-person mediation models using the MLmed macro in SPSS (Rockwood & Hayes, 2019).
Results. There was a significant indirect effect of within-person increases in therapeutic alliance on session-to-session reductions in anxiety and depression through within-person increases in UP skillfulness (abanxiety=–.02, SE=.01, p=.03; abdepression=–.02, SE=.01, p=.02).
Conclusions. These results synthesize theoretically important therapeutic change processes and provide initial evidence of one path by which the UP promotes reductions in anxiety and depression. Clinically, providers may prioritize improving the alliance as one target in sessions to facilitate patients’ skill learning and use.