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Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating
Elizabeth B Ruzicka1, Lauren B Shomaker1, Laura Pyle1
1Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
Objective:
Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes.
Methods:
Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator.
Results:
Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05).
Conclusions:
The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.
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