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Therapist differences in cognitive-behavioral psychotherapy for generalized anxiety disorder: a pilot study
Henny A Westra1, Michael J Constantino, Hal Arkowitz
1Department of Psychology, York University, Toronto, Canada. hwestra@yorku.ca
Psychotherapy (Chicago, Ill.)
|June 22, 2011
Summary
Effective cognitive-behavioral psychotherapy (CBT) relies on therapist competence and client expectations. Higher therapist competence and positive client expectations early in treatment predict better outcomes for generalized anxiety disorder.
Area of Science:
- Psychology
- Clinical Psychology
- Psychotherapy Research
Background:
- Limited understanding of therapist factors influencing psychotherapy effectiveness.
- Mechanisms by which therapists impact treatment outcomes remain unclear.
- Need to identify specific therapist characteristics and client perceptions.
Purpose of the Study:
- To compare the performance of effective versus less effective therapists in cognitive-behavioral psychotherapy (CBT).
- To explore factors differentiating therapist effectiveness and potential mediating mechanisms.
- To investigate the role of therapist competence and client expectations in generalized anxiety disorder treatment.
Main Methods:
- Comparative analysis of 4 therapists delivering CBT to 32 clients with generalized anxiety disorder.
- Assessment of observer-rated CBT competence, client outcome expectations, treatment credibility, and therapeutic alliance.
- Examination of associations between early treatment factors and posttreatment outcomes.
Main Results:
- More effective therapists demonstrated higher CBT competence, client outcome expectations, and early therapeutic alliance ratings.
- Higher early CBT competence correlated with increased client midtreatment outcome expectations.
- Client midtreatment outcome expectations were linked to better posttreatment outcomes.
Conclusions:
- Therapist competence and client outcome expectations are key differentiators of effective CBT for generalized anxiety disorder.
- Client outcome expectations may act as a mechanism through which therapist competence influences treatment success.
- Preliminary findings suggest focusing on enhancing therapist competence and fostering positive client expectations is crucial.
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