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Treatment adherence, therapeutic alliance, and clinical outcomes during an exposure-based cognitive-behavioral
Reut Naim1,2, Ramaris E German3, Jamell White3
1School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Ramat Aviv, 6139001, Israel. reutnaim@tauex.tau.ac.il.
Insights
Treatment adherence and therapeutic alliance are key predictors of successful outcomes in exposure-based cognitive behavioral therapy (CBT) for pediatric irritability. This study examined their roles in a novel parent-and-child psychotherapy.
Area of Science:
- Psychiatry and Behavioral Sciences
- Child and Adolescent Psychology
Background:
- Pediatric irritability is a significant concern requiring effective therapeutic interventions.
- Parent- and child-focused psychotherapies are being developed to address severe irritability in youth.
- Understanding the dynamics of treatment adherence and alliance is crucial for optimizing therapy outcomes.
Purpose of the Study:
- To investigate changes in treatment adherence and therapeutic alliance during a novel parent- and child-psychotherapy for pediatric irritability.
- To examine the associations between in-session therapeutic processes (adherence and alliance) and symptom change in pediatric irritability.
Main Methods:
- Forty children with severe irritability and their parents received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT).
- Clinician-rated adherence, alliance scales (TASC-r, WAI), and clinician-, parent-, and child-reported irritability (ARI) were measured.
- Linear mixed models analyzed session-by-session changes and bidirectional associations between adherence, alliance, and irritability.
Main Results:
- Adherence to standard treatment elements decreased over time, while focus on exposure and PMT increased.
- Higher adherence was associated with decreased clinician-reported irritability.
- Parent-reported alliance increased, while child-reported alliance remained stable.
- Bidirectional associations were found: child-reported alliance predicted subsequent irritability, and decreased irritability predicted increased alliance.
Conclusions:
- Treatment adherence and therapeutic alliance significantly predict outcomes in exposure-based CBT for pediatric irritability.
- These findings highlight the importance of monitoring and fostering both adherence and alliance for effective treatment of pediatric irritability.
Background:
This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.
Methods:
Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.
Results:
First, adherence to standard treatment elements decreased over time (Bs ≥ - 0.03, ps ≤ 0.010), while the focus on specific treatment components increased (i.e., exposure: B = 0.15, p = 0.001; PMT: B = 0.07, p = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (Bs ≥ - 2.23, p ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (Bs ≥ 0.10, p ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (Bs ≥ - 0.66, p ≤ 0.053), and decreases in clinician- (Bs ≥ - 0.02, ps ≤ 0.043) and parent- (B = - 0.15, p = 0.024) reported irritability predicted increased alliance at next session.
Conclusions:
Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.
Trial Registration:
ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.
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