Accepted for/Published in: JMIR Mental Health
Date Submitted: Sep 28, 2020
Date Accepted: Jan 3, 2021
Intolerance of Uncertainty Mediates the Association Between Working Alliance and Treatment Outcome in CBT Delivered by Videoconference for GAD
ABSTRACT
Background:
Previous meta-analyses have shown a significant relation between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to our knowledge no study has examined the mediating role of individual components of the working alliance.
Objective:
As part of a clinical trial of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference, we examined the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome.
Methods:
A sample of 44 adults with primary GAD received 15 sessions of CBT delivered over videoconference for GAD. The measure of working alliance was completed by participants after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process), was assessed from pre- to post-treatment. Treatment outcome was assessed via change in GAD symptoms from pre-treatment to 6-month follow-up.
Results:
Results revealed that the therapeutic bond did not predict treatment outcome (r = -.23, P = .14). However, agreement on therapeutic goals and tasks did predict treatment outcome (rs = -.41 and -.37, respectively, Ps < .05). Also, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by change in intolerance of uncertainty (b = -0.03, r2 = .11), whereas consensus relative to treatment goals had a direct impact on outcome.
Conclusions:
These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy, as a facilitative factor for change in key cognitive processes, leading to therapeutic change. Clinical Trial: Is psychotherapy delivered in videoconference as effective as in face to face for GAD? ISRCTN12662027 https://doi.org/10.1186/ISRCTN12662027
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