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      A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

      1 , 1 , 1 , 1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 1
      The International journal of eating disorders
      eating disorder, meta-analysis, therapeutic alliance, treatment outcome

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          The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments. Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter-relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta-análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, ฆยs = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.

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          Int J Eat Disord
          The International journal of eating disorders
          Feb 02 2017
          [1 ] Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States.
          [2 ] Centre Hospitalier Lorquin, Lorquin, France.
          [3 ] Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom.
          [4 ] Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, United States.
          [5 ] Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States and Institute fur Psychologie, University of Bern, Bern, Switzerland.
          [6 ] Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, United States.
          [7 ] Division of Child & Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
          [8 ] Pediatric Eating Disorders Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
          [9 ] Anorexia-Bulimia Eating Disorder Unit, The Sahlgrenska University Hospital, Gothenburg, Sweden.
          [10 ] ZZP Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany.
          [11 ] Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany and Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany.
          [12 ] Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States.
          [13 ] Niccolò Cusano University, Roma, Italy.
          [14 ] Department of Psychiatry, University of Colorado Denver, Denver, Colorado, United States.
          [15 ] School of Psychology, Social Work, and Social Policy, University of South Australia, South Australia, Australia.
          [16 ] School of Nursing Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
          [17 ] Department of Health and Social Care Sciences, St. George's, University of London, London, England, United Kingdom.
          [18 ] Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine and The School of Social Service Administration, University of Chicago, Chicago, Illinois, United States.
          [19 ] Brain and Mind Research Institute, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada.
          [20 ] Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
          [21 ] Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.
          [22 ] The University of Michigan Comprehensive Eating Disorders Program, Ann Arbor, Michigan, United States.
          [23 ] Department of Psychiatry, University of California, San Francisco, California, United States.

          eating disorder,meta-analysis,therapeutic alliance,treatment outcome


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