The therapeutic alliance in cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis.
OCD
alliance-outcome association
therapeutic alliance
therapeutic relationship
working alliance
Journal
Frontiers in psychiatry
ISSN: 1664-0640
Titre abrégé: Front Psychiatry
Pays: Switzerland
ID NLM: 101545006
Informations de publication
Date de publication:
2022
2022
Historique:
received:
24
05
2022
accepted:
01
08
2022
entrez:
23
9
2022
pubmed:
24
9
2022
medline:
24
9
2022
Statut:
epublish
Résumé
The therapeutic alliance has been recognized as one of the most researched key elements of treatment across different therapeutic approaches and diagnostic domains. Despite its importance, our current understanding of its clinical relevance in patients with obsessive-compulsive disorder (OCD) is still debated. This study aimed to examine empirical evidence on the effect of alliance on treatment outcomes in Cognitive Behavioral Therapy (CBT) in patients with OCD in a systematic review and meta-analysis. Original peer-reviewed articles until March 2022 were included if they were (1) written in English; (2) included a clinical group with a current primary OCD diagnosis; (3) involved individual CBT; (4) used a validated therapeutic alliance scale that was related to the outcome measurement; (5) reported an effect size. Thirteen studies were included, six of which contained sufficient statistical information to be included in the meta-analysis. A total of 897 patients took part in all reviewed studies. We found a modest effect of alliance on post-treatment outcome [ The results show the existence of considerable variability and methodological inconsistencies across studies. We discuss the role of methodological factors that could account for this divergence, the research limitations, and the implications for current research. [https://osf.io/dxez5/?view_only=bc2deaa7f0794c8dbef440255b2d4b3b].
Sections du résumé
Background
UNASSIGNED
The therapeutic alliance has been recognized as one of the most researched key elements of treatment across different therapeutic approaches and diagnostic domains. Despite its importance, our current understanding of its clinical relevance in patients with obsessive-compulsive disorder (OCD) is still debated. This study aimed to examine empirical evidence on the effect of alliance on treatment outcomes in Cognitive Behavioral Therapy (CBT) in patients with OCD in a systematic review and meta-analysis.
Methods
UNASSIGNED
Original peer-reviewed articles until March 2022 were included if they were (1) written in English; (2) included a clinical group with a current primary OCD diagnosis; (3) involved individual CBT; (4) used a validated therapeutic alliance scale that was related to the outcome measurement; (5) reported an effect size.
Results
UNASSIGNED
Thirteen studies were included, six of which contained sufficient statistical information to be included in the meta-analysis. A total of 897 patients took part in all reviewed studies. We found a modest effect of alliance on post-treatment outcome [
Discussion
UNASSIGNED
The results show the existence of considerable variability and methodological inconsistencies across studies. We discuss the role of methodological factors that could account for this divergence, the research limitations, and the implications for current research.
Systematic review registration
UNASSIGNED
[https://osf.io/dxez5/?view_only=bc2deaa7f0794c8dbef440255b2d4b3b].
Identifiants
pubmed: 36147968
doi: 10.3389/fpsyt.2022.951925
pmc: PMC9488733
doi:
Types de publication
Systematic Review
Langues
eng
Pagination
951925Informations de copyright
Copyright © 2022 Strappini, Socci, Saliani, Grossi, D’Ari, Damato, Pompili, Alessandri and Mancini.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Psychotherapy (Chic). 2018 Dec;55(4):316-340
pubmed: 29792475
J Trauma Stress. 2021 Aug;34(4):819-828
pubmed: 33772892
Trends Psychiatry Psychother. 2020 Jul-Sep;42(3):256-261
pubmed: 33084803
Epidemiol Rev. 2008;30:1-14
pubmed: 18806255
JAMA. 2004 Oct 27;292(16):1969-76
pubmed: 15507582
J Anxiety Disord. 2016 May;40:8-17
pubmed: 27061971
J Anxiety Disord. 2020 Dec;76:102322
pubmed: 33035773
J Appl Psychol. 2005 Jan;90(1):175-81
pubmed: 15641898
Behav Res Ther. 2018 Jun;105:43-51
pubmed: 29621650
Psychotherapy (Chic). 2006 Fall;43(3):286-91
pubmed: 22122099
Clin Psychol Rev. 2015 Dec;42:72-82
pubmed: 26319194
Arch Gen Psychiatry. 2002 Oct;59(10):877-83
pubmed: 12365874
Clin Psychol Rev. 2011 Nov;31(7):1083-100
pubmed: 21820387
J Consult Clin Psychol. 2005 Jun;73(3):498-505
pubmed: 15982147
Am J Psychiatry. 2008 May;165(5):621-30
pubmed: 18316422
Psychother Psychosom. 2016;85(2):117-8
pubmed: 26807976
J Consult Clin Psychol. 2021 Mar;89(3):214-226
pubmed: 33829809
J Consult Clin Psychol. 1989 Feb;57(1):138-47
pubmed: 2925964
Compr Psychiatry. 2017 Jul;76:79-86
pubmed: 28433854
Open Med. 2009;3(3):e123-30
pubmed: 21603045
Arch Gen Psychiatry. 2005 Jun;62(6):617-27
pubmed: 15939839
Clin Psychol Rev. 2015 Aug;40:156-69
pubmed: 26117062
Psychol Assess. 2010 Jun;22(2):223-32
pubmed: 20528050
Crit Care. 2016 Apr 20;20(Suppl 2):94
pubmed: 27885969
Psychol Assess. 2002 Dec;14(4):485-96
pubmed: 12501574
Behav Res Ther. 2017 Jul;94:81-92
pubmed: 28544896
Psychother Res. 2013;23(4):394-418
pubmed: 23461273
J Anxiety Disord. 2020 Mar;70:102194
pubmed: 32007734
Int J Eat Disord. 2017 Apr;50(4):323-340
pubmed: 28152196
Clin Psychol Psychother. 2017 May;24(3):785-792
pubmed: 27699920
Behav Res Methods Instrum Comput. 2004 Nov;36(4):717-31
pubmed: 15641418
J Pers Soc Psychol. 1986 Dec;51(6):1173-82
pubmed: 3806354
J Obsessive Compuls Relat Disord. 2012 Oct 1;1(4):251-257
pubmed: 22924159
Clin Psychol Psychother. 2017 Sep;24(5):1109-1120
pubmed: 28194835
J Couns Psychol. 2021 Mar;68(2):194-207
pubmed: 32614193
J Consult Clin Psychol. 2000 Dec;68(6):1027-32
pubmed: 11142536
J Consult Clin Psychol. 2000 Jun;68(3):438-50
pubmed: 10883561
Behav Res Ther. 2005 Dec;43(12):1543-58
pubmed: 16239151
Psychotherapy (Chic). 2010 Dec;47(4):637-45
pubmed: 21198249
Psychother Res. 2018 Nov;28(6):969-984
pubmed: 28355973
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
Psychother Res. 2017 Jul;27(4):410-424
pubmed: 26829714
J Consult Clin Psychol. 2011 Apr;79(2):247-252
pubmed: 21355639
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
J Behav Ther Exp Psychiatry. 2006 Sep;37(3):247-55
pubmed: 16460667
Psychother Res. 2021 Jun;31(5):573-588
pubmed: 32957850
Clin Psychol Rev. 2020 Dec;82:101921
pubmed: 33069096
Psychopharmacol Bull. 1993;29(2):321-6
pubmed: 8290681
Psychol Assess. 2010 Mar;22(1):180-98
pubmed: 20230164
BMC Med. 2013 Sep 12;11:202
pubmed: 24229007
J Clin Epidemiol. 2009 Oct;62(10):e1-34
pubmed: 19631507
Psychother Res. 2020 Jun;30(5):591-603
pubmed: 32400306
Psychiatry Res. 2010 Sep 30;179(2):198-203
pubmed: 20483484
Psychotherapy (Chic). 2018 Dec;55(4):303-315
pubmed: 30335448
Clin Psychol Rev. 2008 Dec;28(8):1310-25
pubmed: 18701199
J Consult Clin Psychol. 2007 Dec;75(6):842-52
pubmed: 18085902
Behav Res Ther. 1977;15(5):389-95
pubmed: 612339
Behav Res Ther. 1985;23(5):571-83
pubmed: 4051930
Psychotherapy (Chic). 2014 Sep;51(3):327-33
pubmed: 25068190
Psychol Methods. 2004 Dec;9(4):426-45
pubmed: 15598097
Psychother Psychosom. 2012;81(2):124-6
pubmed: 22301680
J Consult Clin Psychol. 2007 Jun;75(3):508-12
pubmed: 17563167
Int Clin Psychopharmacol. 2007 Jul;22(4):230-7
pubmed: 17519647
Hum Brain Mapp. 2022 Jul;43(10):3037-3046
pubmed: 35384125
Psychoanal Q. 2008 Jan;77(1):77-102
pubmed: 18386657
J Consult Clin Psychol. 1996 Jun;64(3):532-9
pubmed: 8698947
Struct Equ Modeling. 2003 Apr 1;10(2):238
pubmed: 20157639
Arch Gen Psychiatry. 1989 Nov;46(11):1012-6
pubmed: 2510699
Transl Psychiatry. 2022 Jan 10;12(1):5
pubmed: 35013105
Clin Psychol Rev. 2006 Jan;26(1):17-31
pubmed: 16199119
Int J Surg. 2021 Apr;88:105906
pubmed: 33789826
Front Psychiatry. 2022 Mar 24;13:658693
pubmed: 35401280
Psychotherapy (Chic). 2015 Mar;52(1):67-77
pubmed: 25751116
Mol Psychiatry. 2010 Jan;15(1):53-63
pubmed: 18725912
Clin Neuropsychiatry. 2016 Dec;13(6):88-93
pubmed: 33981347
J Anxiety Disord. 2011 Oct;25(7):855-63
pubmed: 21621966
J Couns Psychol. 2012 Jan;59(1):10-7
pubmed: 21988681
J Consult Clin Psychol. 2019 Aug;87(8):734-744
pubmed: 31219276
J Consult Clin Psychol. 1996 Dec;64(6):1326-36
pubmed: 8991319
Br J Clin Psychol. 1989 May;28(2):185-6
pubmed: 2743059
Clin Psychol Rev. 2008 Oct;28(7):1167-87
pubmed: 18538907
J Appl Psychol. 2018 Jun;103(6):644-658
pubmed: 29369653
J Psychiatr Res. 2013 Jan;47(1):33-41
pubmed: 22999486
Br J Psychiatry. 1994 Dec;165(6):781-6
pubmed: 7661936
Annu Rev Clin Psychol. 2007;3:29-51
pubmed: 17716047