Therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa

Authors

  • Colleen Stiles-Shields MA,

    Corresponding author
    1. Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    2. Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
    • Correspondence to: Colleen Stiles-Shields, MA, Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Chicago, IL 60611. E-mail: colleenss@u.northwestern.edu

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  • Stephen Touyz PhD,

    1. School of Psychology, University of Sydney, Sydney, Australia
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  • Phillipa Hay MD,

    1. Centre for Health Research, School of Medicine, University of Western Sydney, Sydney, Australia
    2. School of Medicine, James Cook University, Townsville, Australia
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  • Hubert Lacey MD,

    1. Eating Disorders Research Team, St. George's Hospital, University of London, London, United Kingdom
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  • Ross D. Crosby PhD,

    1. Neuropsychiatric Research Institute, Fargo, North Dakota
    2. University of North Dakota School of Medicine, Grand Forks, North Dakota
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  • Elizabeth Rieger PhD,

    1. Research School of Psychology, Australian National University, Canberra, Australia
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  • Bryony Bamford DClinPsy,

    1. Eating Disorders Research Team, St. George's Hospital, University of London, London, United Kingdom
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  • Daniel Le Grange PhD

    1. Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
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ABSTRACT

Objective

The aim of this study was to investigate the strength and role of therapeutic alliance in a trial comparing Cognitive Behavioral Therapy for anorexia nervosa (CBT-AN) and Specialist Supportive Clinical Management for the treatment of severe and enduring AN (SE-AN).

Method

Participants were 63 adult females with SE-AN presenting to an outpatient, multisite randomized controlled trial conducted at two clinical sites. Participants completed measures assessing their perception of the quality of the therapeutic relationship, eating disorder (ED) symptomatology, and depressive symptomatology.

Results

Beyond the effect of early treatment change and treatment assignment, early therapeutic alliance was a significant predictor of Restraint and Shape Concern at follow-up (ps < .02). Late therapeutic alliance was a significant predictor of weight change, depressive symptomatology, and ED symptomatology at end of treatment and follow-up (ps < .008), with the exception of Shape Concern at follow-up (p = .07).

Discussion

The results suggest that therapeutic alliance can be effectively established in the treatment of SE-AN and may be relevant for treatment response, particularly in late treatment, on some aspects of ED and depressive symptomatology. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:783–789)

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