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Contribution of working alliance to manual -based treatment of social anxiety disorder

Melanie Marie VanDyke, University of Nebraska - Lincoln


This study examined the contribution of working alliance and other treatment variables to manual-based CBT for social anxiety disorder. Alliance, a common therapy factor, has been discussed in traditional psychotherapy literature and has recently received attention due to its correlation with outcome across different therapy methods. The broad circulation of treatment manuals raised concerns that the emphasis on specific techniques may impede the therapeutic relationship. The rationale for choosing social anxiety disorder included the serious nature of the disorder, the availability of an effective treatment protocol, and the cognitive biases and interpersonal difficulties inherent to the disorder. This study examined the utility of pre-treatment depression, treatment credibility and expectancy, and homework compliance as factors associated with outcome. Both a clinician-rated severity measure of distress and functional impairment and a self-report fear of negative evaluation scale were used to assess treatment gains. This study was conducted in the context of a wait-list controlled trial of individual cognitive-behavioral social anxiety disorder treatment. Results indicated that treatment significantly reduced symptom severity, fear of negative evaluation, and depressive symptomatology. Despite cognitive biases and interpersonal difficulties, participants had alliance ratings equivalent to general outpatient samples. After controlling for pre-treatment severity, working alliance after the final session was related to the post-treatment clinician-rated severity measure. This relationship suggested that working alliance developed in the context of improving in treatment, refuting a causal role for alliance. After controlling for pre-treatment scores, initial depression severity significantly contributed to post-treatment fear of negative evaluation model in the intent to treat sample. This relationship suggested the importance of considering comorbid depressive symptoms in treatment. However, initial levels of depression were not associated with outcome in individuals who completed treatment. Treatment implications, study limitations, and future directions were discussed. ^

Subject Area

Psychology, Clinical

Recommended Citation

VanDyke, Melanie Marie, "Contribution of working alliance to manual -based treatment of social anxiety disorder" (2002). ETD collection for University of Nebraska - Lincoln. AAI3064572.