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The Course of the Working Alliance during Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder

Published online by Cambridge University Press:  17 October 2013

Irene Ngai ,
Erin C. Tully  and
Page L. Anderson
Irene Ngai
Affiliation:
Georgia State University, Atlanta, USA
Erin C. Tully
Affiliation:
Georgia State University, Atlanta, USA
Page L. Anderson*
Affiliation:
Georgia State University, Atlanta, USA
*
Reprint requests to Page Anderson, Department of Psychology, Georgia State University, PO Box 5010, Atlanta, Georgia 30302, USA. E-mail: [email protected]
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Abstract

Background: Psychoanalytic theory and some empirical research suggest the working alliance follows a “rupture and repair” pattern over the course of therapy, but given its emphasis on collaboration, cognitive behavioral therapy may yield a different trajectory. Aims: The current study compares the trajectory of the working alliance during two types of cognitive behavioral therapy for social anxiety disorder – virtual reality exposure therapy (VRE) and exposure group therapy (EGT), one of which (VRE) has been proposed to show lower levels of working alliance due to the physical barriers posed by the technology (e.g. no eye contact with therapist during exposure). Method: Following randomization, participants (N = 63) diagnosed with social anxiety disorder received eight sessions of manualized EGT or individual VRE and completed a standardized self-report measure of working alliance after each session. Results: Hierarchical linear modeling showed overall high levels of working alliance that changed in rates of growth over time; that is, increases in working alliance scores were steeper at the beginning of therapy and slowed towards the end of therapy. There were no differences in working alliance between the two treatment groups. Conclusion: Results neither support a rupture/repair pattern nor the idea that the working alliance is lower for VRE participants. Findings are consistent with the idea that different therapeutic approaches may yield different working alliance trajectories.

Keywords

Social anxiety disorderworking alliancevirtual reality exposure therapyexposure group therapycognitive behavioral therapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 2 , March 2015 , pp. 167 - 181
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Alden, L. E. and Taylor, C. T. (2004). Interpersonal processes in social phobia. Clinical Psychology Review, 24, 857–882.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
Anderson, P., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., et al. (in press). Virtual reality exposure therapy for social phobia: a randomized clinical trial. Journal of Consulting and Clinical Psychology.Google Scholar
Anderson, P. L., Zimand, E., Hodges, L. F. and Rothbaum, B.O. (2005). Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22, 156–158.Google Scholar
Anderson, R. E., Spence, S. H., Donovan, C. L., March, S., Prosser, S. and Kenardy, J. (2012). Working alliance in online cognitive behavior therapy for anxiety disorders in youth: comparison with clinic delivery and its role in predicting outcome. Journal of Medical Internet Research. 14, e88. PMID:22789657Google Scholar
Andersson, G., Carlbring, P., Holmström, A., Sparthan, E., Furmark, T., Nilsson-Ihrfelt, E., et al. (2006). Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 677–686.Google Scholar
Assay, T. P. and Lambert, M. J. (1999). The empirical case for the common factors in therapy: quantitative findings. In Hubble, M. A., Duncan, B. L. and Miller, S. D. (Eds.), The Heart and Soul of Change: what works in therapy (pp. 23–55). Washington, DC: American Psychological Association.Google Scholar
Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.CrossRefGoogle Scholar
Busseri, M. A. and Tyler, J. D. (2003). Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychological Assessment, 15, 193–197.Google Scholar
Chou, K. (2009). Social anxiety disorder in older adults: evidence from the National Epidemiologic Survey on alcohol and related conditions. Journal of Affective Disorders, 119, 76–83.CrossRefGoogle ScholarPubMed
First, M. B., Gibbon, M., Spitzer, R. L. and Williams, J. B. W. (2002). Structured Clinical Interview for the DSM-IV-TR Axis 1 Disorders. New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
Gelso, C. J. and Carter, J. A. (1994). Components of the psychotherapy relationship: their interaction and unfolding during treatment. Journal of Counseling Psychology, 41, 296–306.Google Scholar
Golden, B. R. and Robbins, S. B. (1990). The working alliance within time-limited therapy: a case analysis. Professional Psychology: Research and Practice, 21, 476–481.CrossRefGoogle Scholar
Hatcher, R. L. and Gillaspy, J. A. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16, 12–25.Google Scholar
Hayes, S. A., Hope, D. A., Van Dyke, M. M. and Heimberg, R. G. (2007). Working alliance for clients with social anxiety disorder: relationship with session helpfulness and within-session habituation. Cognitive Behaviour Therapy, 36, 34–42.Google Scholar
Hoffart, A., Borge, F., Sexton, H. and Clark, D. M. (2009). The role of common factors in residential cognitive and interpersonal therapy for social phobia: a process-outcome study. Psychotherapy Research, 19, 54–67.Google Scholar
Hofmann, S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72, 392–399.Google Scholar
Horvath, A. O. and Bedi, R. P. (2002). The alliance. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work: therapist contributions and responsiveness to patients (pp.37–69). New York: Oxford University Press.Google Scholar
Horvath, A. O. and Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.CrossRefGoogle Scholar
Horvath, A. O. and Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561–573.Google Scholar
Horvath, A. O. and Marx, R. W. (1990). The development and decay of the working alliance during time-limited counseling. Canadian Journal of Counseling, 24, 240–259.Google Scholar
Horvath, A. O. and Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: a meta-analysis. Journal of Counseling Psychology, 38, 139–149.CrossRefGoogle Scholar
Kivlighan, D. M. and Shaughnessy, P. (1995). Analysis of the development of the working alliance using hierarchical linear modeling. Journal of Counseling Psychology, 42, 338–349.CrossRefGoogle Scholar
Kivlighan, D. M. and Shaughnessy, P. (2000). Patterns of working alliance development: a typology of client's working alliance ratings. Journal of Counseling Psychology, 47, 362–371.CrossRefGoogle Scholar
Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F., Chemin, I., et al. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study. Cyber Psychology and Behavior, 8, 76–88.CrossRefGoogle ScholarPubMed
Martin, D. J., Garske, J. P. and Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438–450.CrossRefGoogle ScholarPubMed
Meyerbroker, K. and Emmelkamp, P. M. G. (2008). Therapeutic processes in virtual reality exposure therapy: the role of cognitions and the therapeutic alliance. Journal of Cyber Therapy and Rehabilitation, 1, 247–257.Google Scholar
Powers, M. and Emmelkamp, P. M. G. (2008). Virtual reality exposure therapy for anxiety disorders: a meta-analysis. Journal of Anxiety Disorders, 22, 561–569.Google Scholar
Raudenbush, S. W. and Bryk, A. S. (2002). Hierarchical Linear Models: applications and data analysis methods. Thousand Oaks, CA: Sage Publications.Google Scholar
Raudenbush, S. W., Bryk, A. S. and Congdon, R. (2004). HLM 6 for Windows [Computer software]. Skokie, IL: Scientified Software International, Inc.Google Scholar
Safran, J. D., Crocker, P., McMain, S. and Murray, P. (1990). Therapeutic alliance rupture as a therapy event for empirical investigation. Psychotherapy, 27, 154–165.Google Scholar
Stiles, W. B., Glick, M. J., Osatuke, K., Hardy, G. E., Shapiro, D. A., Agnew-Davies, R., et al. (2004). Patterns of alliance development and the rupture-repair hypothesis: are productive relationships U-shaped or V-shaped? Journal of Counseling Psychology, 51, 81–92.CrossRefGoogle Scholar
Tracey, T. J. and Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207–120.Google Scholar
Wallach, H. S., Safir, M. and Bar-Zvi, M. (2009). Virtual reality cognitive behavior therapy for public speaking anxiety: a randomized clinical trial. Behavior Modification, 33, 314–333.Google Scholar
Walling, S. M., Suvak, M. K., Howard, J. M., Taft, C. T. and Murphy, C. M. (2011). Race/ethnicity as a predictor of change in working alliance during cognitive behavioral therapy for intimate partner violence. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0025751.Google Scholar
Woody, S. R. and Adessky, R. S. (2002). Therapeutic alliance, group cohesion, and homework compliance during cognitive-behavioral group treatment of social phobia. Behavior Therapy, 33, 5–27.Google Scholar
Wrzesien, M., Burkhardt, J., Botella, C. and Alcaniz, M. (2012). Evaluation of the quality of collaboration between the client and the therapist in phobia treatments. Interacting with Computers, 24, 461–471.CrossRefGoogle Scholar
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