The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis

Christoph Flückiger; Julian Rubel; A. C. Del Re; Adam O. Horvath; Bruce E. Wampold; Paul Crits-Christoph; Dana Atzil-Slonim; Angelo Compare; Fredrik Falkenström; Annika Ekeblad; Paula Errázuriz; Hadar Fisher; Asle Hoffart; Jonathan D. Huppert; Yogev Kivity; Manasi Kumar; Wolfgang Lutz; John Christopher Muran; Daniel R. Strunk; Giorgio A. Tasca; Andreea Vîslă; Ulrich Voderholzer; Christian A. Webb; Hui Xu; Sigal Zilcha-Mano; Jacques P. Barber

doi:10.1037/ccp0000594

The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis

Christoph Flückiger, Julian Rubel, A. C. Del Re, Adam O. Horvath, Bruce E. Wampold, Paul Crits-Christoph, Dana Atzil-Slonim, Angelo Compare, Fredrik Falkenström, Annika Ekeblad, Paula Errázuriz, Hadar Fisher, Asle Hoffart, Jonathan D. Huppert, Yogev Kivity, Manasi Kumar, Wolfgang Lutz, John Christopher Muran, Daniel R. Strunk, Giorgio A. TascaAndreea Vîslă, Ulrich Voderholzer, Christian A. Webb, Hui Xu, Sigal Zilcha-Mano, Jacques P. Barber

Department of Psychology

Research output: Contribution to journal › Article › peer-review

141 Scopus citations

Abstract

Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.

Original language	English
Pages (from-to)	829-843
Number of pages	15
Journal	Journal of Consulting and Clinical Psychology
Volume	88
Issue number	9
DOIs	https://doi.org/10.1037/ccp0000594
State	Published - Sep 2020

Bibliographical note

Publisher Copyright:
© 2020 American Psychological Association.

Funding

There is no prior manuscript that analyzed this set of data. Furthermore, there is no manuscript submitted or in pipeline that is based on the present dataset. We do not intend to further publish any manuscript with the same set of data. This study was supported by the Swiss National Science Foundation (Grant PP00P1_163702) and the Foundation for Research in Science University of Zurich (Grant: STWF-19-018; Principal investigator: Christoph Flückiger). We are very thankful for the investigators and authors of the primary studies for their contribution to this meta-analysis. The authors’ list and its alphabetic order do not represent the sequence of engagement of the primary study investigators to collect their datasets, and it does not represent the conceptual and methodological innovations of all the authors engaged in the primary manuscripts. More explicit standards are necessary on how to conduct meta-analysis that investigates individual participant datasets, particularly when integrating future open source datasets.

Funders	Funder number
Foundation for Research in Science University of Zurich	STWF-19-018
Fogarty International Center	K43TW010716
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung	PP00P1_163702

Keywords

Early response
Individual participant data meta-analysis
Process-based therapy
Within-patient effects
Working alliance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1037/ccp0000594

Cite this

Flückiger, C., Rubel, J., Del Re, A. C., Horvath, A. O., Wampold, B. E., Crits-Christoph, P., Atzil-Slonim, D., Compare, A., Falkenström, F., Ekeblad, A., Errázuriz, P., Fisher, H., Hoffart, A., Huppert, J. D., Kivity, Y., Kumar, M., Lutz, W., Muran, J. C., Strunk, D. R., ... Barber, J. P. (2020). The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis. Journal of Consulting and Clinical Psychology, 88(9), 829-843. https://doi.org/10.1037/ccp0000594

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abstract = "Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.",

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author = "Christoph Fl{\"u}ckiger and Julian Rubel and {Del Re}, {A. C.} and Horvath, {Adam O.} and Wampold, {Bruce E.} and Paul Crits-Christoph and Dana Atzil-Slonim and Angelo Compare and Fredrik Falkenstr{\"o}m and Annika Ekeblad and Paula Err{\'a}zuriz and Hadar Fisher and Asle Hoffart and Huppert, {Jonathan D.} and Yogev Kivity and Manasi Kumar and Wolfgang Lutz and Muran, {John Christopher} and Strunk, {Daniel R.} and Tasca, {Giorgio A.} and Andreea V{\^i}sl{\u a} and Ulrich Voderholzer and Webb, {Christian A.} and Hui Xu and Sigal Zilcha-Mano and Barber, {Jacques P.}",

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Flückiger, C, Rubel, J, Del Re, AC, Horvath, AO, Wampold, BE, Crits-Christoph, P, Atzil-Slonim, D, Compare, A, Falkenström, F, Ekeblad, A, Errázuriz, P, Fisher, H, Hoffart, A, Huppert, JD, Kivity, Y, Kumar, M, Lutz, W, Muran, JC, Strunk, DR, Tasca, GA, Vîslă, A, Voderholzer, U, Webb, CA, Xu, H, Zilcha-Mano, S & Barber, JP 2020, 'The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis', Journal of Consulting and Clinical Psychology, vol. 88, no. 9, pp. 829-843. https://doi.org/10.1037/ccp0000594

TY - JOUR

T1 - The reciprocal relationship between alliance and early treatment symptoms

T2 - A two-stage individual participant data meta-analysis

AU - Flückiger, Christoph

AU - Rubel, Julian

AU - Del Re, A. C.

AU - Horvath, Adam O.

AU - Wampold, Bruce E.

AU - Crits-Christoph, Paul

AU - Atzil-Slonim, Dana

AU - Compare, Angelo

AU - Falkenström, Fredrik

AU - Ekeblad, Annika

AU - Errázuriz, Paula

AU - Fisher, Hadar

AU - Hoffart, Asle

AU - Huppert, Jonathan D.

AU - Kivity, Yogev

AU - Kumar, Manasi

AU - Lutz, Wolfgang

AU - Muran, John Christopher

AU - Strunk, Daniel R.

AU - Tasca, Giorgio A.

AU - Vîslă, Andreea

AU - Voderholzer, Ulrich

AU - Webb, Christian A.

AU - Xu, Hui

AU - Zilcha-Mano, Sigal

AU - Barber, Jacques P.

PY - 2020/9

Y1 - 2020/9

N2 - Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.

AB - Objective: Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method: We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results: In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion: The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge.

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KW - Individual participant data meta-analysis

KW - Process-based therapy

KW - Within-patient effects

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The reciprocal relationship between alliance and early treatment symptoms: A two-stage individual participant data meta-analysis

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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