Predictors of therapeutic alliance in two treatments for adults with severe and enduring anorexia nervosa.

Colleen Stiles-Shields,Bryony H Bamford,Daniel Le Grange,Hubert Lacey,Stephen Touyz,Phillipa Hay

doi:10.1186/s40337-016-0102-6

Abstract

BackgroundTherapeutic alliance (TA) has been found to be a significant predictor of outcome for patients with severe and enduring anorexia nervosa (SE-AN), accounting for more variance than treatment type. To better understand how to promote TA for this population, the aim of the current study was to investigate predictors of TA in adults with SE-AN.MethodsParticipants were 63 adult females with SE-AN presenting to an outpatient, multi-site randomized controlled trial conducted at two clinical sites. Participants’ perception of the quality of their therapeutic relationship, demographic information, and eating disorder symptomatology were assessed via interview and questionnaire measures.ResultsBaseline ratings of how successful participants believed treatment would be for them was the only variable to significantly predict early (p = .01), mid (p = .009), and late treatment alliance (p = .03). No other variables investigated predicted the quality of patient rated TA at any point in treatment (ps > .57).ConclusionsResults suggest instilling hope in treatment outcome may enhance TA, and in turn, outcomes for patients with SE-AN in outpatient therapy.

Highlights

Therapeutic alliance (TA) has been found to be a significant predictor of outcome for patients with severe and enduring anorexia nervosa (SE-AN), accounting for more variance than treatment type
While TA is recognized as an important predictor of treatment engagement, less is known about the factors that may contribute to the development of a strong alliance in patients with AN, those with a severe and enduring course of illness
To determine if a significant meditational effect was present among the significant predictor(s) of TA, TA, and Results A total of 63 participants were randomized to Cognitive Behavioral Therapy for anorexia nervosa (CBT-AN) (n = 31) or Specialist Supportive Clinical Management (SSCM) (n = 32)

Summary

Introduction

Therapeutic alliance (TA) has been found to be a significant predictor of outcome for patients with severe and enduring anorexia nervosa (SE-AN), accounting for more variance than treatment type. While TA is recognized as an important predictor of treatment engagement, less is known about the factors that may contribute to the development of a strong alliance in patients with AN, those with a severe and enduring course of illness. The quality of the therapeutic relationship has been noted as worse in individuals with chronic eating disorders [22], suggesting that duration of illness, or number of previous treatment episodes may adversely affect treatment engagement and TA.

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