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Title: The role of therapeutic alliance and early behavioural change during cognitive behavioural therapy for anorexia nervosa
Author: Brown, Amy
Awarding Body: University of London
Current Institution: University of London
Date of Award: 2012
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Cognitive behavioural therapy (CBT) is often the treatment of choice for the outpatient treatment of anorexia nervosa. However, little is known about which elements of the therapy bring about change. This study explored two potential change processes: early therapeutic alliance and early behavioural change. In Study 1, the temporal relationship between therapeutic alliance and weight gain during CBT for anorexia nervosa was examined in a cohort of 65 adults with a diagnosis of anorexia nervosa (or atypical anorexia nervosa). Patients completed a measure of alliance at session 6 (early therapeutic alliance) and at the end of treatment. Early behavioural change was defined as weight gain over the first six sessions. Early therapeutic alliance was associated with neither the likelihood of completing treatment norwith subsequent weight gain. Thus, no evidence was found that therapeutic alliance is a process that brings about change during CBT for this client group. The data indicated that it was vice versa: behavioural change (measured by weight gain) was predictive of subsequent alliance strength. Treatment completers had made more early behavioural changes (measured by weight gain) compared to those who prematurely discontinued treatment, but early weight gain was negatively associated with later weight gain. In Study 2, 100 clinicians who deliver CBT for anorexia nervosa completed a survey that explored beliefs and clinical practice related to therapeutic alliance and early behavioural change. Responses indicated that clinicians consider both processes to be important change processes, with particular emphasis placed on early therapeutic alliance. The gap between the clinicians' perspective and the empirical findings of Study 1 are discussed, with reference to the potential influences of the existing evidence base and information processing errors.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available