Category: Treatment - Other

PS3- #C76 - Does Working Alliance Moderate the Relationship Between Baseline and Treatment Outcome in Patients With Borderline Traits and Anxiety?

Friday, Nov 17
11:00 AM – 12:00 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Adult Anxiety | Borderline Personality Disorder | 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