Abstract
BackgroundIt has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques.MethodsTE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients’ and caregivers’ TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients’ and caregivers’ working alliance, as well as patients’ collaboration were assessed at mid-treatment, patients’ PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores.ResultsPatients’ or caregivers’ TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients’ or caregivers’ TE via patients’ collaboration or patients’ or caregivers’ working alliance. Caregivers’ working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: β = − 0.553; p < 0.001; PTSS difference score: β = 0.335; p = 0.031).ConclusionsTE seems less important than caregivers’ working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.
Highlights
It has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration
Kirsch et al Child Adolesc Psychiatry Ment Health (2018) 12:16 aspects, psychiatric disorders and the individuality of the patient, to improve therapeutic success [2, 3]. This integrative approach seems helpful in the context of post-traumatic stress disorder (PTSD), a severe and chronic psychiatric condition leading to profound psychosocial impairment
We focused on TE in TF-Cognitive Behavioral Therapy (CBT) and investigated direct effects of patients’ and caregivers’ TE on treatment outcome as well as indirect effects via working alliance and patients’ collaboration
Summary
It has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. Kirsch et al Child Adolesc Psychiatry Ment Health (2018) 12:16 aspects, psychiatric disorders and the individuality of the patient, to improve therapeutic success [2, 3] This integrative approach seems helpful in the context of post-traumatic stress disorder (PTSD), a severe and chronic psychiatric condition leading to profound psychosocial impairment. The ability to anticipate a positive outcome is decreased; patients might become less responsive to common factors For such patients, evidence based treatment techniques, like exposure to trauma related stimuli, may be more important than common factors in order to facilitate symptom reduction [6, 7]. A good relationship with the therapist and positive outcome expectations seem essential prerequisites to engage patients in challenging exposure techniques, especially patients showing avoidant behavior as usual in PTSD [8], highlighting the importance of common factors
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