{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T03:30:56Z","timestamp":1786505456431,"version":"build-2736575974"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Eating Disorders"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The role of the therapeutic alliance (TA) in treatment outcomes of anorexia nervosa (AN) appears to be less substantial than in other disorders. However, the therapeutic process is a complex trajectory with many variables influencing each other. Hence, investigating motivation to change in the bidirectional interplay between TA and outcome among patients with AN may enhance the understanding of these processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>In an exploratory analysis of longitudinal data from 173 inpatients with AN assessed at four time points in a specialized in\u2010patient clinic, the interplay of TA and its subscales with motivation was investigated using cross\u2010lagged panel models. Additionally, motivation was tested as a possible moderator and mediator of previously examined relationships between outcome and TA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Autoregressive paths of TA and motivation were highly stable over the course of treatment, while residual covariances varied. Motivation showed moderate but significant cross\u2010lagged effects on subsequent TA, while TA had no effect on subsequent motivation. These associations were observed only when motivation was assessed with an exploratory measure of motivation. No mediation and moderation effect of motivation on relationships between TA and outcome was found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Cross\u2010lagged analyses suggested that motivation preceded subsequent levels of TA, whereas TA did not predict subsequent motivation. Given the exploratory nature of the study, these findings should be considered hypothesis\u2010generating and require replication. Future research using more fine\u2010grained methodologies may help to further elucidate the longitudinal interplay between motivation and TA in patients with AN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/eat.70189","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T03:15:21Z","timestamp":1786504521000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Motivation to Change, Therapeutic Alliance and Outcome\u2014A Complex Interaction in Patients With Anorexia Nervosa"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4846-0391","authenticated-orcid":false,"given":"Janina","family":"Werz","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology Albert\u2010Ludwigs\u2010University Freiburg  Freiburg Germany"},{"name":"Department of Clinical Psychology and Trauma Therapy University of the Bundeswehr Munich  Neubiberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2565-7792","authenticated-orcid":false,"given":"Brunna","family":"Tuschen\u2010Caffier","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology Albert\u2010Ludwigs\u2010University Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0261-3145","authenticated-orcid":false,"given":"Ulrich","family":"Voderholzer","sequence":"additional","affiliation":[{"name":"Sch\u00f6n Klinik Roseneck  Prien am Chiemsee Germany"},{"name":"Department of Psychiatry and Psychotherapy University Hospital, Ludwig Maximilians University  Munich Germany"},{"name":"Department of Psychiatry and Psychotherapy Albert\u2010Ludwigs\u2010University Freiburg  Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.1186\/1471-244X-14-69","article-title":"Pre\u2010Treatment Predictors of Attrition in a Randomised Controlled Trial of Psychological Therapy for Severe and Enduring Anorexia Nervosa","volume":"14","author":"Abd Elbaky G. 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