The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis : A meta-analysis

Journal article


Browne, Julia, Wright, Abigail C., Berry, Katherine, Mueser, Kim T., Cather, Corinne, Penn, David L. and Kurtz, Matthew M.. (2021). The alliance-outcome relationship in individual psychosocial treatment for schizophrenia and early psychosis : A meta-analysis. Schizophrenia Research. 231, pp. 154-163. https://doi.org/10.1016/j.schres.2021.04.002
AuthorsBrowne, Julia, Wright, Abigail C., Berry, Katherine, Mueser, Kim T., Cather, Corinne, Penn, David L. and Kurtz, Matthew M.
Abstract

The therapeutic alliance, or client-provider relationship, has been associated with better treatment engagement and outcomes for persons with schizophrenia-spectrum disorders (SSDs) and early psychosis in some studies, but not others. We conducted a meta-analysis of the research on alliance in SSDs and early psychosis across a range of interventions and outcomes. Parallel literature searches were conducted in PubMed and PsycINFO databases for articles between inception and 6/11/2020. English-language studies were included if they evaluated the relationship between alliance and a prospective outcome (treatment engagement, medication adherence, functioning, or total, positive, negative, or depressive symptoms) in an individual clinical treatment for SSDs/early psychosis and contained analyzable data. Correlations and partial correlations were meta-analyzed with random effects models to calculate mean across-study correlations and to carry out subsequent homogeneity and moderator variable analyses. Fourteen studies consisting of 2968 participants that assessed six outcomes across six psychosocial treatments were included. Results indicated that better client-rated (r = 0.20) and other-rated (i.e., provider- or observer-rated; r = 0.25) alliance were associated with better treatment engagement. Treatment type and sample race/ethnicity, but not age, gender, or timing of alliance rating moderated the association between other-rated alliance and engagement. Further, better other-rated alliance was related to improvements in positive (r = −0.14) and negative (r = −0.22) symptoms. A strong therapeutic alliance is important for both engaging clients with SSDs and early psychosis in treatment and facilitating improvements in positive and negative symptoms. Delivery and monitoring of treatments for this population should include assessment of the therapeutic alliance from multiple perspectives.

Keywordstherapeutic relationship; working alliance; therapeutic alliance; treatment-outcome research; serious mental illness; engagement
Year2021
JournalSchizophrenia Research
Journal citation231, pp. 154-163
PublisherElsevier BV
ISSN0920-9964
Digital Object Identifier (DOI)https://doi.org/10.1016/j.schres.2021.04.002
Scopus EID2-s2.0-85104142121
Research or scholarlyResearch
Page range154-163
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All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online15 Apr 2021
Publication process dates
Accepted08 Apr 2021
Deposited24 Nov 2021
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Uzenoff, S. R., Brewer, K. C., Perkins, D. O., Johnson, D P., Mueser, Kim T. and Penn, David. (2010). Psychological well-being among individuals with first-episode psychosis. Early Intervention in Psychiatry: the development, onset and treatment of emerging mental disorders. 4(2), pp. 174 - 181. https://doi.org/10.1111/j.1751-7893.2010.00178.x
Upward spirals of positive emotions counter downward spirals of negativity: insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology
Garland, E. L., Fredrickson, B. L., Kring, A. M., Johnson, D P., Meyer, P and Penn, David. (2010). Upward spirals of positive emotions counter downward spirals of negativity: insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clinical Psychology Review. 30(7), pp. 849 - 864. https://doi.org/10.1016/j.cpr.2010.03.002
Social skill and social cognition in adolescents at genetic risk for psychosis
Gibson, Clare, Penn, David, Prinstein, M, Perkins, D and Belger, A. (2010). Social skill and social cognition in adolescents at genetic risk for psychosis. Schizophrenia Research. 122(1-3), pp. 179 - 184. https://doi.org/10.1016/j.schres.2010.04.018
Transportability and feasibility of Social Cognition and interaction Training (SCiT) in community settings
Roberts, D. L., Penn, David, Labate, D., Margolis, S A. and Sterne, A. (2010). Transportability and feasibility of Social Cognition and interaction Training (SCiT) in community settings. Behavioural and Cognitive Psychotherapy. 38(1), pp. 35 - 47. https://doi.org/10.1017/S1352465809990464
Neuropsychological profile of autism and the broad autism phenotype
Losh, M., Adolphs, R., Poe, M. D., Couture, S M., Penn, David, Baranek, G T. and Piven, J. (2009). Neuropsychological profile of autism and the broad autism phenotype. Archives of General Psychiatry. 66(5), pp. 518 - 526. https://doi.org/10.1001/archgenpsychiatry.2009.34
Loving-kindness meditation to enhance recovery from negative symptoms of schizophrenia
Johnson, D. P., Penn, David, Fredrickson, B. L., Meyer, P, Kring, A M. and Brantley, M. (2009). Loving-kindness meditation to enhance recovery from negative symptoms of schizophrenia. Journal of Clinical Psychology. 65(5), pp. 499 - 509. https://doi.org/10.1002/jclp.20591
Social cognition and interaction training (SCiT) for outpatients with schizophrenia: A preliminary study
Roberts, D. L. and Penn, David. (2009). Social cognition and interaction training (SCiT) for outpatients with schizophrenia: A preliminary study. Psychiatry Research. 166(43892), pp. 141 - 147. https://doi.org/10.1016/j.psychres.2008.02.007
Perceptions of hostility by persons with and without persecutory delusions
Combs, D. R., Penn, David, Michael, C. O., Basso, M R., Wiedeman, R, Siebenmorgan, M and Tiegreen, J A.. (2009). Perceptions of hostility by persons with and without persecutory delusions. Cognitive Neuropsychiatry. 14(1), pp. 30 - 52. https://doi.org/10.1080/13546800902732970
Stability and generalization of Social Cognition and interaction Training (SCiT) for schizophrenia: Six-month follow-up results
Combs, D. R., Penn, David, Tiegreen, J. A., Nelson, Andre, Ledet, S N., Basso, M R. and Elerson, K. (2009). Stability and generalization of Social Cognition and interaction Training (SCiT) for schizophrenia: Six-month follow-up results. Schizophrenia Research. 112(43891), pp. 196 - 197. https://doi.org/10.1016/j.schres.2009.04.010
The effects of task engagement and interpersonal rapport on WCST performance in schizophrenia
Roberts, D. L. and Penn, David. (2009). The effects of task engagement and interpersonal rapport on WCST performance in schizophrenia. American Journal of Psychiatric Rehabilitation. 12(1), pp. 57 - 72. https://doi.org/10.1080/15487760802615798
The effects of antipsychotic medications on emotion perception in patients with chronic schizophrenia in the CATiE trial
Penn, David, Keefe, R. S., Davis, Stephen, Meyer, P, Perkins, D O., Losardo, D and Lieberman, J A.. (2009). The effects of antipsychotic medications on emotion perception in patients with chronic schizophrenia in the CATiE trial. Schizophrenia Research. 115(1), pp. 17 - 23. https://doi.org/10.1016/j.schres.2009.08.016
An investigation of the relationship between activation of a social cognitive neural network and social functioning
Pinkham, Amy E., Hopfinger, J. B., Ruparel, K and Penn, David. (2008). An investigation of the relationship between activation of a social cognitive neural network and social functioning. Schizophrenia Bulletin. 34(4), pp. 688 - 697. https://doi.org/10.1093/schbul/sbn031
Social cognition training for individuals with schizophrenia: Emerging evidence
Horan, William P., Kern, R. S., Green, M. F. and Penn, David. (2008). Social cognition training for individuals with schizophrenia: Emerging evidence. American Journal of Psychiatric Rehabilitation. 11(3), pp. 205 - 252. https://doi.org/10.1080/15487760801963652
A Preliminary trial of adherence-coping-education (ACE) therapy for early psychosis
Uzenoff, S. R., Perkins, D. O., Hamer, R. M., Wiesen, C A. and Penn, David. (2008). A Preliminary trial of adherence-coping-education (ACE) therapy for early psychosis. Journal of Nervous and Mental Disease. 196(7), pp. 572 - 575. https://doi.org/10.1097/NMD.0b013e31817d01a5
Social cognition in schizophrenia: An overview
Penn, David, Sanna, L. J. and Roberts, D. L.. (2008). Social cognition in schizophrenia: An overview. Schizophrenia Bulletin. 34(3), pp. 408 - 411. https://doi.org/10.1093/schbul/sbn014
The graduated recovery intervention program for first episode psychosis: Treatment development and preliminary data
Waldheter, E., Penn, David, Perkins, D. O., Mueser, Kim T., Owens, L W. and Cook, E. (2008). The graduated recovery intervention program for first episode psychosis: Treatment development and preliminary data. Community Mental Health Journal. 44(6), pp. 443 - 455. https://doi.org/10.1007/s10597-008-9147-6
Social functioning in individuals at clinical high risk for psychosis
Addington, Jean, Penn, David, Woods, Scott W., Addington, D and Perkins, D O.. (2008). Social functioning in individuals at clinical high risk for psychosis. Schizophrenia Research. 99(43891), pp. 119 - 124. https://doi.org/10.1016/j.schres.2007.10.001
Adherence-coping-education therapy for early psychosis
Penn, David and Uzenoff, S. R.. (2008). Adherence-coping-education therapy for early psychosis. Journal of Nervous and Mental Disease. 196(10), p. 780. https://doi.org/10.1097/NMD.0b013e318187bfff
Facial affect recognition in individuals at clinical high risk for psychosis
Penn, David, Addington, Jean, Woods, Scott W., Addington, D and Perkins, D O.. (2008). Facial affect recognition in individuals at clinical high risk for psychosis. British Journal of Psychiatry. 192(1), pp. 67 - 68. https://doi.org/10.1192/bjp.bp.107.039784
Neural bases for impaired social cognition in schizophrenia and autism spectrum disorders
Pinkham, Amy E., Hopfinger, J. B., Pelphrey, K. A., Piven, J and Penn, David. (2008). Neural bases for impaired social cognition in schizophrenia and autism spectrum disorders. Schizophrenia Research. 99(43891), pp. 164 - 175. https://doi.org/10.1016/j.schres.2007.10.024
Brief report: Feasibility of social cognition and interaction training for adults with high functioning autism
Turner-Brown, L. M., Perry, T. D., Dichter, G. S., Bodfish, J W. and Penn, David. (2008). Brief report: Feasibility of social cognition and interaction training for adults with high functioning autism. Journal of Autism and Developmental Disorders. 38(9), pp. 1777 - 1784. https://doi.org/10.1007/s10803-008-0545-y
Predictors of the therapeutc alliance in group therapy for individuals with treatment-resistant auditory hallucinations
Johnson, D. P., Penn, David, Bauer, D. J. and Meyer, P. (2008). Predictors of the therapeutc alliance in group therapy for individuals with treatment-resistant auditory hallucinations. British Journal of Clinical Psychology. 47(2), pp. 171 - 183. https://doi.org/10.1348/014466507X241604
Assessment of social judgments and complex mental states in the early phases of psychosis
Couture, S. M., Penn, David, Addington, Jean, Woods, Scott W. and Perkins, D O.. (2008). Assessment of social judgments and complex mental states in the early phases of psychosis. Schizophrenia Research. 100(43891), pp. 237 - 241. https://doi.org/10.1016/j.schres.2007.12.484
Social cognition in schizophrenia: An NiMH workshop on definitions, assessment, and research opportunities
Green, M. F., Penn, David, Bentall, R., Carpenter, W T., Gaebel, W, Gur, R C., Kring, A M., Park, Sung-Yun, Silverstein, S M. and Heinssen, Robert. (2008). Social cognition in schizophrenia: An NiMH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin. 34(6), pp. 1211 - 1220. https://doi.org/10.1093/schbul/sbm145
Attentional-shaping as a means to improve emotion perception deficits in schizophrenia
Combs, D. R., Tosheva, A., Penn, David, Basso, M R., Wanner, J L. and Laib, K. (2008). Attentional-shaping as a means to improve emotion perception deficits in schizophrenia. Schizophrenia Research. 105(43891), pp. 68 - 77. https://doi.org/10.1016/j.schres.2008.05.018
Recognizing and responding to early psychosis: A qualitative analysis of individual narratives
Judge, A., Estroff, Sue E., Perkins, D. O. and Penn, David. (2008). Recognizing and responding to early psychosis: A qualitative analysis of individual narratives. Psychiatric Services. 59(1), pp. 96 - 99. https://doi.org/10.1176/appi.ps.59.1.96