2021/07/23 by Yogev Kivity, Asher Y. Strauss, Jonathan Elizur +3 · 6 citations
Psychology · #Alliance #Anxiety #Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes #Clinical psychology #Cognition #Cognitive behavioral therapy #Digital Mental Health Interventions #Outcome (game theory) #Psychiatry #Psychology #Psychotherapist #Psychotherapy Techniques and Applications #Sawtooth wave #Social anxiety
paper · doi:10.1002/jclp.23219
published in Journal of Clinical Psychology 78(2), 122-136 (Wiley)
openalex publication_date 2021/07/23 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
OBJECTIVES: We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within- and decreases between-sessions) and sudden gains and their association with outcome. METHODS: Clients received CBT (n = 33) or ABM (n = 17). Client-rated alliance was measured before and after each session. Self-reported and clinician-rated anxiety were measured weekly and monthly, respectively. RESULTS: The alliance increased in CBT in a sawtooth pattern and did not change in ABM. When examining individual clients, sawtooths were more common in CBT (61% clients) than in ABM (6%) and predicted worse outcome in CBT. Sudden gains were equally frequent (CBT, 18%; ABM, 18%) and did not predict outcome. CONCLUSION: The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome.