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Background <p>This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.</p> Methods <p>Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.</p> Results <p>First, adherence to standard treatment elements decreased over time (<i>B</i>s ≥ − 0.03, <i>p</i>s ≤ 0.010), while the focus on&#xa0;specific treatment components increased (i.e., exposure: <i>B</i> = 0.15, <i>p</i> = 0.001; PMT: <i>B</i> = 0.07, <i>p</i> = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (<i>B</i>s ≥ − 2.23, <i>p</i> ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (<i>B</i>s ≥ 0.10, <i>p</i> ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (<i>B</i>s ≥ − 0.66, <i>p</i> ≤ 0.053), and decreases in clinician- (<i>B</i>s ≥ − 0.02, <i>p</i>s ≤ 0.043) and parent- (<i>B</i> = − 0.15, <i>p</i> = 0.024) reported irritability predicted increased alliance at next session.</p> Conclusions <p>Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.</p> Trial registration <p> ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.</p>

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Treatment adherence, therapeutic alliance, and clinical outcomes during an exposure-based cognitive-behavioral therapy for pediatric irritability

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月26日

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  • Reut Naim,
  • Ramaris E. German,
  • Jamell White,
  • Urmi Pandya,
  • Kelly Dombek,
  • Michal Clayton,
  • Samantha Perlstein,
  • Lauren M. Henry,
  • Katharina Kircanski,
  • Lorenzo Lorenzo-Luaces,
  • Melissa A. Brotman

摘要

Background

This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.

Methods

Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.

Results

First, adherence to standard treatment elements decreased over time (Bs ≥ − 0.03, ps ≤ 0.010), while the focus on specific treatment components increased (i.e., exposure: B = 0.15, p = 0.001; PMT: B = 0.07, p = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (Bs ≥ − 2.23, p ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (Bs ≥ 0.10, p ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (Bs ≥ − 0.66, p ≤ 0.053), and decreases in clinician- (Bs ≥ − 0.02, ps ≤ 0.043) and parent- (B = − 0.15, p = 0.024) reported irritability predicted increased alliance at next session.

Conclusions

Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.

Trial registration

ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.