{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:11:46Z","timestamp":1792599106624,"version":"4.5.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Therapeutic alliance has consistently been found to predict treatment outcomes across various psychotherapies and patient diagnosis. However, the relationship between therapeutic alliance and outcome in Cognitive Behavioral Therapy (CBT) has shown mixed results. This study investigated the impact of different aspects of therapeutic alliance in CBT for Obsessive-Compulsive Disorder (OCD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Data from two previously completed randomized controlled trials of 208 patients with OCD and their therapists were analyzed. Therapeutic alliance was assessed at week 4 of treatment with the patient-rated and therapist-rated Working Alliance Inventory (WAI), which includes three subscales to measure alliance domains (Goal, Task and Bond). Higher WAI score reflects a better therapeutic relationship. OCD severity was rated by independent assessors at baseline and post-treatment using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Linear regression analyses were used to examine the effects of the different aspects of therapeutic alliance on treatment outcome, adjusted for baseline symptom severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A higher total WAI score as rated by therapists significantly predicted a lower post-treatment Y-BOCS. Further, higher scores on the Goal and Task subscales of the WAI were associated with lower post-treatment severity. However, these significant outcomes reflected only small effect sizes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the treatment of OCD, the strength of the therapeutic alliance contributes to outcomes, though to a limited extent. Effective OCD treatment involves the delivery of specific therapy interventions, in the context of a strong therapeutic alliance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2022.658693","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T20:45:53Z","timestamp":1648500353000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["Therapeutic Alliance and Treatment Outcome in Cognitive Behavior Therapy for Obsessive-Compulsive Disorder"],"prefix":"10.3389","volume":"13","author":[{"given":"Nadja","family":"Wolf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia van","family":"Oppen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriaan W.","family":"Hoogendoorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton J. L. M. van","family":"Balkom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henny A. D.","family":"Visser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1037\/0033-3204.38.4.357","article-title":"Research summary on the therapeutic relationship and psychotherapy outcome","volume":"38","author":"Lambert","year":"2001","journal-title":"Psychotherapy."},{"key":"B2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1093\/clipsy.9.1.21","article-title":"Let's face the facts: Common factors are more potent than specific therapy ingredients","volume":"9","author":"Messer","year":"2002","journal-title":"Clin Psychol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1093\/clipsy.9.1.30","article-title":"The dodo bird is extinct","volume":"9","author":"Beutler","year":"2002","journal-title":"Clin Psychol."},{"key":"B4","first-page":"69","article-title":"The dodo bird, treatment technique, and disseminating empirically supported treatments","volume":"32","author":"Siev","year":"2009","journal-title":"Behav Ther."},{"key":"B5","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1037\/pst0000172","article-title":"The alliance in adult psychotherapy: a meta-analytic synthesis","volume":"55","author":"Fl\u00fcckiger","year":"2018","journal-title":"Psychotherapy."},{"key":"B6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1037\/a0025749","article-title":"How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis","volume":"59","author":"Fl\u00fcckiger","year":"2012","journal-title":"J Counsel Psychol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1037\/cou0000424","article-title":"Assessing the alliance\u2013outcome association adjusted for patient characteristics and treatment processes: a meta-analytic summary of direct comparisons","volume":"67","author":"Fl\u00fcckiger","year":"2020","journal-title":"J Counsel Psychol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1037\/h0085885","article-title":"The generalizability of the psychoanalytic concept of the working alliance","volume":"16","author":"Bordin","year":"1979","journal-title":"Psychotherapy."},{"key":"B9","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1080\/21674086.1965.11926343","article-title":"The working alliance and the transference neurosis","volume":"34","author":"Greenson","year":"1965","journal-title":"Psychoanal Q."},{"key":"B10","volume-title":"Cognitive Therapy: Basics and Beyond","author":"Beck","year":"1995"},{"key":"B11","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1037\/0022-006X.64.3.497","article-title":"Predicting the effect of cognitive therapy for depression: a study of unique and common factors","volume":"64","author":"Castonguay","year":"1996","journal-title":"J Consult Clin Psychol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1037\/a0022659","article-title":"Patient adherence predicts outcome from cognitive-behavioral therapy in obsessive-compulsive disorder","volume":"79","author":"Simpson","year":"2011","journal-title":"J Consult Clin Psychol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.brat.2013.01.008","article-title":"Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa","volume":"51","author":"Brown","year":"2013","journal-title":"Behav Res Ther."},{"key":"B14","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.brat.2015.06.006","article-title":"Evaluating changes in judgmental biases as mechanisms of cognitive-behavioral therapy for social anxiety disorder","volume":"71","author":"Calamaras","year":"2015","journal-title":"Behav Res Ther."},{"key":"B15","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.brat.2018.03.007","article-title":"What matters more? Common or specific factors in cognitive behavioral therapy for OCD: therapeutic alliance and expectations as predictors of treatment outcome","volume":"105","author":"Strauss","year":"2018","journal-title":"Behav Res Ther."},{"key":"B16","first-page":"88","article-title":"How important is the therapeutic alliance in treating obsessive-compulsive disorder with exposure and response prevention? An empirical report","volume":"13","author":"Wheaton","year":"2016","journal-title":"Clin Neuropsychiatry."},{"key":"B17","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/j.2044-8260.1989.tb00831.x","article-title":"The significance of the patient-therapist relationship in the treatment of obsessive-compulsive neurosis","volume":"28","author":"Hoogduin","year":"1989","journal-title":"Br J Clin Psychol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1192\/bjp.165.6.781","article-title":"Predictors of treatment outcome in the behavioural treatment of obsessive-compulsive disorder","volume":"165","author":"Keijsers","year":"1994","journal-title":"Br J Psychiatry."},{"key":"B19","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1159\/000330214","article-title":"Predictors of patient adherence to cognitive-behavioral therapy for obsessive-compulsive disorder","volume":"81","author":"Maher","year":"2012","journal-title":"Psychother Psychosom."},{"key":"B20","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.jbtep.2005.12.001","article-title":"Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD","volume":"37","author":"Vogel","year":"2006","journal-title":"J Behav Ther Exp Psychiatry."},{"key":"B21","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1037\/a0023252","article-title":"Two aspects of the therapeutic alliance: differantial relations with depressive symptom change","volume":"79","author":"Webb","year":"2011","journal-title":"J Consult Clin Psychol."},{"key":"B22","first-page":"94","article-title":"Therapist variability in the task\/goal dimension of the early working alliance predicts outcome in exposure and response prevention treatment for obsessive-compulsive disorder","volume":"13","author":"Hagen","year":"2016","journal-title":"Clin Neuropsychiatry."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.4088\/JCP.08m04990blu","article-title":"Does the therapy manual or the therapist matter most in treatment of obsessive-compulsive disorder? A randomized controlled trial of exposure with response or ritual prevention in 118 patients","volume":"71","author":"van Oppen","year":"2010","journal-title":"J Clin Psychiatry."},{"key":"B24","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1159\/000382131","article-title":"Inference-based approach versus cognitive behavioral therapy in the treatment of obsessive-compulsive disorder with poor insight: a 24-session randomized controlled trial","volume":"84","author":"Visser","year":"2015","journal-title":"Psychother Psychosom."},{"key":"B25","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1001\/archpsyc.1992.01820080032005","article-title":"The Structured Clinical Interview for DSM-III-R (SCID): I: history, rationale, and description","volume":"49","author":"Spitzer","year":"1992","journal-title":"Arch Gen Psychiatry."},{"key":"B26","volume-title":"Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition. (SCID-I\/P version 2.0).","author":"First","year":"1996"},{"key":"B27","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.jad.2016.05.060","article-title":"The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change","volume":"202","author":"Julien","year":"2016","journal-title":"J Affect Disord."},{"key":"B28","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1037\/0022-0167.36.2.223","article-title":"Development and validation of the working alliance inventory","volume":"36","author":"Horvath","year":"1989","journal-title":"J Couns Psychol."},{"key":"B29","volume-title":"Werkalliantievragenlijst (WAV). Vertaling voor experimenteel gebruik van WAI (Horvath & Greenberg 1986)","author":"Vertommen","year":"1990"},{"key":"B30","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1037\/0022-006X.68.3.438","article-title":"Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review","volume":"68","author":"Martin","year":"2000","journal-title":"J Consult Clin Psychol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1001\/archpsyc.1989.01810110054008","article-title":"The yale\u2013brown obsessive compulsive scale II validity","volume":"46","author":"Goodman","year":"1989","journal-title":"Arch Gen Psychiatry."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1001\/archpsyc.1989.01810110048007","article-title":"The Yale-brown obsessive compulsive scale: I. Development, use, and reliability","volume":"46","author":"Goodman","year":"1989","journal-title":"Arch Gen Psychiatry."},{"key":"B33","doi-asserted-by":"publisher","first-page":"73","DOI":"10.5334\/pb.584","article-title":"Nederlandstalige revisie van Barrett-Lennard's Relationship Inventory voor individueel-therapeutische relaties","volume":"16","author":"Lietaer","year":"1976","journal-title":"Psychol Belg."},{"key":"B34","volume-title":"Obsessions and Compulsions","author":"Rachman","year":"1980"},{"key":"B35","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/0005-7967(83)90002-5","article-title":"Spouse involvement in the treatment of obsessive-compulsive patients","volume":"21","author":"Emmelkamp","year":"1983","journal-title":"Behav Res Ther."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10503300802609680","article-title":"Toward a working through of some core conflicts in psychotherapy research","volume":"19","author":"Barber","year":"2009","journal-title":"Psychother Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1037\/0033-3204.43.3.280","article-title":"Does the alliance cause good outcome? Recommendations for future research on the alliance","volume":"43","author":"Crits-Christoph","year":"2006","journal-title":"Psychotherapy."},{"key":"B38","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1080\/10503300512331327038","article-title":"Looking beyond the negatives: a time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive-behavior therapy for panic disorder","volume":"15","author":"Casey","year":"2005","journal-title":"Psychother Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1159\/000049340","article-title":"Quality of early working alliance in psychotherapy: diagnoses, relationship and intrapsychic variables as predictors","volume":"71","author":"Hersoug","year":"2001","journal-title":"Psychother Psychosom."},{"key":"B40","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1891\/0889.8391.22.1.68","article-title":"Therapist-patient alliance, patient-therapist alliance, mutual therapeutic alliance, therapist-patient concordance, and outcome of CBT in GAD","volume":"22","author":"Langhoff","year":"2008","journal-title":"J Cogn Psychother."},{"key":"B41","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/14659890500137004","article-title":"Differences in client and therapist views of the working alliance in drug treatment","volume":"11","author":"Meier","year":"2006","journal-title":"J Subst Use."},{"key":"B42","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1080\/10503300701320611","article-title":"A meta-analytic examination of client-therapist perspectives of the working alliance","volume":"17","author":"Tryon","year":"2007","journal-title":"Psychother Res."},{"key":"B43","doi-asserted-by":"publisher","first-page":"102194","DOI":"10.1016\/j.janxdis.2020.102194","article-title":"The therapeutic alliance in exposure therapy for anxiety-related disorders: a critical review","volume":"70","author":"Buchholz","year":"2020","journal-title":"J Anxiety Disord."},{"key":"B44","doi-asserted-by":"publisher","first-page":"102322","DOI":"10.1016\/j.janxdis.2020.102322","article-title":"Elements of the therapeutic relationship in CBT for anxiety disorders: a systematic review","volume":"76","author":"Luong","year":"2020","journal-title":"J Anxiety Disord."},{"key":"B45","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1002\/eat.22672","article-title":"A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders","volume":"50","author":"Graves","year":"2017","journal-title":"Int J Eat Disord."},{"key":"B46","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1002\/cpp.2180","article-title":"The relationship between the therapeutic alliance and clinical outcomes in cognitive behaviour therapy for adults with depression: a meta-analytic review","volume":"25","author":"Cameron","year":"2018","journal-title":"Clin Psychol Psychother."},{"key":"B47","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1037\/ccp0000594","article-title":"The reciprocal relationship between alliance and early treatment symptoms: a two-stage individual participant data meta-analysis","volume":"88","author":"Fl\u00fcckiger","year":"2020","journal-title":"J Consult Clin Psychol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.comppsych.2016.10.004","article-title":"The effect of treatment on quality of life and functioning in OCD","volume":"73","author":"Asnaani","year":"2017","journal-title":"Compr Psychiatry."},{"key":"B49","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.comppsych.2005.04.002","article-title":"Quality of life in obsessive-compulsive disorder before and after treatment","volume":"46","author":"Moritz","year":"2005","journal-title":"Compr Psychiatry."},{"key":"B50","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1037\/0022-006X.75.6.842","article-title":"Untangling the alliance-outcome correlation: exploring the relative importance of therapist and patient variability in the alliance","volume":"75","author":"Baldwin","year":"2007","journal-title":"J Consult Clin Psychol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1016\/j.cpr.2012.07.002","article-title":"Therapist effects in the therapeutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis","volume":"32","author":"del Re","year":"2012","journal-title":"Clin Psychol Rev."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.658693\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T20:46:00Z","timestamp":1648500360000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.658693\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,24]]},"references-count":51,"alternative-id":["10.3389\/fpsyt.2022.658693"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2022.658693","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,24]]},"article-number":"658693"}}