Elements of the therapeutic relationship in CBT for anxiety disorders: A systematic review

•Systematic review exploring therapeutic relationships in CBT for anxiety disorders.•Group cohesion, treatment expectations, and collaboration predict improved outcomes.•Ruptures in the relationship predict worse outcomes.•Evidence for the effect of the alliance and empathy on outcomes is mixed.•Fur...

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Bibliographic Details
Published in:Journal of anxiety disorders 2020-12, Vol.76, p.102322-102322, Article 102322
Main Authors: Luong, Hoang K., Drummond, Sean P.A., Norton, Peter J.
Format: Article
Language:English
Subjects:
Anxiety disorders
Anxiety Disorders - therapy
Cognitive behavior therapy
Cognitive Behavioral Therapy
Humans
Motivation
Psychotherapeutic processes
Treatment Outcome
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Summary:•Systematic review exploring therapeutic relationships in CBT for anxiety disorders.•Group cohesion, treatment expectations, and collaboration predict improved outcomes.•Ruptures in the relationship predict worse outcomes.•Evidence for the effect of the alliance and empathy on outcomes is mixed.•Further research is needed to clarify the role of the relationship in treatment. To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential “active ingredient” of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.
ISSN:0887-6185
1873-7897
DOI:10.1016/j.janxdis.2020.102322