{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:30:22Z","timestamp":1784867422893,"version":"3.55.0"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003977","name":"Israel Science Foundation","doi-asserted-by":"publisher","award":["332\/09"],"award-info":[{"award-number":["332\/09"]}],"id":[{"id":"10.13039\/501100003977","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Clin Psychol"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>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\u2010 and decreases between\u2010sessions) and sudden gains and their association with outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clients received CBT (<jats:italic>n<\/jats:italic>\u2009=\u200933) or ABM (<jats:italic>n<\/jats:italic>\u2009=\u200917). Client\u2010rated alliance was measured before and after each session. Self\u2010reported and clinician\u2010rated anxiety were measured weekly and monthly, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jclp.23219","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T20:18:41Z","timestamp":1627071521000},"page":"122-136","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patterns of alliance development in cognitive behavioral therapy versus attention bias modification for social anxiety disorder: Sawtooth patterns and sudden gains"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8293-8910","authenticated-orcid":false,"given":"Yogev","family":"Kivity","sequence":"first","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8558-0961","authenticated-orcid":false,"given":"Asher Y.","family":"Strauss","sequence":"additional","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Elizur","sequence":"additional","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lior","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0537-4701","authenticated-orcid":false,"given":"Jonathan D.","family":"Huppert","sequence":"additional","affiliation":[{"name":"Department of Psychology The Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118653920.ch8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890423349"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0016685"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2013.871080"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2015.1119908"},{"key":"e_1_2_10_7_1","volume-title":"The therapeutic alliance: An evidence\u2010based approach to practice and training","author":"Castonguay L. 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