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A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders
Authors:Tiffany A. Graves MA  Nassim Tabri PhD  Heather Thompson‐Brenner PhD  Debra L. Franko PhD  Kamryn T. Eddy PhD  Stephanie Bourion‐Bedes MD  Amy Brown PhD  Michael J. Constantino PhD  Christoph Flückiger PhD  Sarah Forsberg PsyD  Leanna Isserlin MD  Jennifer Couturier MD  Gunilla Paulson Karlsson MD  Johannes Mander PhD  Martin Teufel MD  James E. Mitchell MD  Ross D. Crosby PhD  Claudia Prestano PhD  Dana A. Satir PhD  Susan Simpson DClinPsych  Richard Sly PhD  J. Hubert Lacey MD  Colleen Stiles‐Shields  Giorgio A. Tasca PhD  Glenn Waller DPhil  Shannon L. Zaitsoff PhD  Renee Rienecke PhD  Daniel Le Grange PhD  Jennifer J. Thomas PhD
Affiliation:1. Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States;2. Centre Hospitalier Lorquin, Lorquin, France;3. Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom;4. Department of Psychological and Brain Sciences, University of Massachusetts‐Amherst, Amherst, Massachusetts, United States;5. Department of Psychology, University of Wisconsin‐Madison, Madison, Wisconsin, United States and Institute fur Psychologie, University of Bern, Bern, Switzerland;6. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, United States;7. Division of Child & Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada;8. Pediatric Eating Disorders Program, McMaster Children's Hospital, Hamilton, Ontario, Canada;9. Anorexia‐Bulimia Eating Disorder Unit, The Sahlgrenska University Hospital, Gothenburg, Sweden;10. ZZP Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany;11. Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany and Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg‐Essen, Essen, Germany;12. Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States;13. Niccolò Cusano University, Roma, Italy;14. Department of Psychiatry, University of Colorado Denver, Denver, Colorado, United States;15. School of Psychology, Social Work, and Social Policy, University of South Australia, South Australia, Australia;16. School of Nursing Science, University of East Anglia, Norwich, Norfolk, United Kingdom;17. Department of Health and Social Care Sciences, St. George's, University of London, London, England, United Kingdom;18. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine and The School of Social Service Administration, University of Chicago, Chicago, Illinois, United States;19. Brain and Mind Research Institute, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada;20. Department of Psychology, University of Sheffield, Sheffield, United Kingdom;21. Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada;22. The University of Michigan Comprehensive Eating Disorders Program, Ann Arbor, Michigan, United States;23. Department of Psychiatry, University of California, San Francisco, California, United States
Abstract:The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Keywords:eating disorder  meta‐analysis  therapeutic alliance  treatment outcome
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