Category: Treatment - Other
Exposure and Response Prevention (ERP) is a challenging treatment requiring a strong working alliance between client and therapist (Tracey and Kokotovic, 1989). One factor that might impact treatment outcomes for those with anxiety disorders is comorbid personality traits (e.g., borderline personality traits [BPD]). Comorbidity between anxiety and BPD traits is associated with poorer overall psychosocial functioning, fewer coping skills, and less engagement in therapy (AuBuchon & Malatesta, 1994). A strong working alliance between client and therapist may buffer poorer outcomes for comorbid anxiety and BPD symptoms, given previous associations betweenBPD and tumultuous interpersonal relationships (Gunderson, 2007). We hypothesized that components of the working alliance (bond, task, and goal) would moderate the relationship between comorbid anxiety and BPD traits at baseline and improvement in overall outcome. Participants (N = 67) completed the Working Alliance Inventory, McLean Screening Instrument for BPD, and the Schwartz Outcome Scale at intake and discharge from a unique treatment facility specializing in an intensive outpatient treatment program for anxiety. Standardized residual change scores were calculated for change pre-to-post treatment. Three moderation analyses were conducted using the PROCESS macro with BPD traits at intake as the independent variable, psychological health change as the dependent variable, and working alliance subscale (bond, goal, and task) change as the moderators. The overall models with bond and goal were significant and the interaction explained an additional 7% and 4% of the variance in outcome, F(3, 63) = 6.34, p < .001; F(3, 63) = 13.62, p < .001, respectively. These results suggest that improvement in patients’ perceived bond with the therapist and perceived agreement on the treatment goals may buffer the impact of BPD traits on treatment outcome. Notably, task did not significantly moderate the relationship between BPD traits and outcome p > .05. Clinical implications will be discussed.
Melissa Fasteau– Postdoctoral Fellow, Houston OCD Program, Houston, Texas
Kimberly Stevens– Graduate Student, Southern Illinois University, Carbondale, Illinois
Jennifer Sy– Houston OCD Program
Morgan Willis– Houston OCD Program
Thröstur Björgvinsson– Houston OCD Program, McLean Hospital