Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy

- Attempted to replicate findings of Lorenzo-Luaces, DeRubeis, and Webb (2014).
- In CBT, alliance did not predict outcomes for patients with more prior episodes.
- In CBT, alliance strongly predicted outcomes for patients with fewer prior episodes.
- In psychodynamic therapy, alliance predicted outcome irrespective of prior episodes.
- CBT-specific mechanisms may account for outcomes in more recurrent depression.

Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N = 282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d = 0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d = 0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d = 0.86), moderate for those with 1 prior episode (d = 0.49), and small for those with 2 + prior episodes (d = 0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.