Behavior Therapy最新文献

{"title":"Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans","authors":"Alexander J. Erickson,&nbsp;Gwendolyn C. Carlson,&nbsp;Monica R. Kelly,&nbsp;Michael N. Mitchell,&nbsp;Constance H. Fung,&nbsp;Yeonsu Song,&nbsp;Sarah Kate McGowan,&nbsp;Karen Josephson,&nbsp;Michelle Zeidler,&nbsp;Donna L. Washington,&nbsp;Elizabeth M. Yano,&nbsp;Cathy A. Alessi,&nbsp;Jennifer L. Martin","doi":"10.1016/j.beth.2025.02.003","DOIUrl":"10.1016/j.beth.2025.02.003","url":null,"abstract":"<div><div>Cognitive-behavioral therapy for insomnia (CBT-I) improves comorbid mental health symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), with sleep improvements hypothesized as the mechanism for the observed improvements. This study examined change in insomnia severity as a mediator of mental health symptom improvements in women veterans following behavioral insomnia treatment. Secondary analysis was conducted using data from a comparative effectiveness trial that evaluated insomnia outcomes in women veterans following CBT-I and an acceptance and commitment therapy-informed insomnia (ABC-I) treatment. The treatments were statistically equivalent in improving sleep, so were combined for the current analyses. The sample included 149 middle-age women veterans of diverse race and ethnicity (mean age 48 years, 34.2% White, 26.9% Black or African American, 18.8% Hispanic/Latinx). Variables of interest included insomnia severity (Insomnia Severity Index), and measures of depression (Patient Health Questionnaire–9) and generalized anxiety (Generalized Anxiety Disorder–7). A generalized structural equations model was conducted to test study hypotheses. Study treatment phase (baseline, posttreatment, 3-month follow-up) significantly predicted depression (–3.95 ≤ <em>b</em> ≤ –4.35, <em>p</em> &lt; .001) and anxiety (–4.29 ≤ <em>b</em> ≤ –4.75, <em>p</em> &lt; .001) symptom improvement in nonmediation models. Insomnia severity mediated improvement in depression and anxiety symptoms (0.515 ≤ <em>b</em> ≤ 0.584, <em>p</em> &lt; .001), with change in insomnia severity accounting for 88%–97% of depression and anxiety symptom reduction following insomnia-focused behavioral psychotherapies. This study identified reduction in insomnia severity as a major mechanism of improvement in depression and anxiety symptoms following behavioral insomnia treatment. Findings also reinforce the value of insomnia-focused behavioral psychotherapies in patients with comorbid mental health conditions.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 907-916"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Multifamily App-Enhanced Cognitive-Behavioral Therapy Delivered via Telehealth for Parents of Adolescents With Mood or Psychotic Spectrum Disorders","authors":"Marc J. Weintraub,&nbsp;Megan C. Ichinose,&nbsp;Jamie L. Zinberg,&nbsp;Anabel Salimian,&nbsp;Robin D. Brown,&nbsp;Georga Morgan-Fleming,&nbsp;Jennifer M. Gamarra,&nbsp;Tiffany Tran,&nbsp;David J. Miklowitz","doi":"10.1016/j.beth.2025.02.002","DOIUrl":"10.1016/j.beth.2025.02.002","url":null,"abstract":"<div><div>Parents of youth with mood or psychotic disorders are affected by and also impact the course of their offspring’s psychiatric illness(es). Few studies have examined the effects of family psychotherapy on parents’ mental health in this population. This study involved a multifamily group cognitive-behavioral therapy (CBT) for adolescents with mood or psychotic spectrum disorders and their parents, and tested whether a mobile application (app) could increase therapeutic engagement and skill practice. In a secondary analysis of a randomized controlled trial, we examined whether provision of an adjunctive app was associated with increases in parents' engagement in treatment skill practices and improvements in their emotional and parenting stress. Sixty adolescents and their primary parents were randomized into group cohorts to receive either an app-enhanced group delivery of the CBT unified protocol (AppUP) or the standard delivery of the group UP without an app, both delivered via telehealth. Families were followed over the 9-week treatment and 3 months posttreatment (21 weeks total). Unexpectedly, parents in AppUP reported fewer skill practices than parents in the standard UP. There were no differences between treatment conditions in parents’ psychological distress. In a within-group examination of the full sample (i.e., both treatment conditions), parents with higher psychological distress upon entry to the study showed greater decreases in their distress over the 21-week trial than those with lower distress at entry. These improvements in distress levels were positively associated with parents’ treatment skill practice and improvements in family functioning. Greater parental engagement in skill practice across both treatment conditions was also associated with improvements in adolescents’ psychiatric functioning. Among adolescents with mood or psychotic spectrum disorders, parental engagement in group CBT may contribute to reductions in parents' distress and improvements in the mental health of offspring.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 892-906"},"PeriodicalIF":3.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Trauma and Mental Health: The Adaptive Role of Psychological Flexibility for Young Black Adults","authors":"Jasmin R. Brooks Stephens,&nbsp;Elijah R. Murphy,&nbsp;Matthew W. Gallagher,&nbsp;Rheeda L. Walker","doi":"10.1016/j.beth.2025.02.001","DOIUrl":"10.1016/j.beth.2025.02.001","url":null,"abstract":"<div><div>Although recent work has highlighted the relation of racial trauma and adverse mental health sequelae specifically among Black Americans, the potential mechanisms underlying these associations remain relatively unknown. The present study examined psychological flexibility as a mediator of the association between racial trauma and symptoms of depression, suicide ideation, and anxiety. A sample of 417 Black young adults between the ages of 18 and 29 (53.5% male; <em>M</em>_age = 24.7, <em>SD</em> = 2.5) were recruited from a southwestern public university and social media to complete an online self-report survey. Structural equation modeling (SEM) analyses revealed significant indirect effects of racial trauma on increased symptoms of depression, anxiety, and suicide ideation via lower levels of psychological flexibility. This study demonstrated a link between racial trauma and depressive symptoms, anxiety, and suicide ideation, providing further evidence for the significant psychological burden of racial trauma. Additionally, study findings suggest that psychological flexibility is a key intervention target that may reduce the adverse impact of race-based traumatic stress for Black young adults.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 5","pages":"Pages 879-891"},"PeriodicalIF":3.8,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Depressive Symptoms on Overidentification of Anger in Couples: A Daily Diary Study","authors":"Ramya Ramadurai,&nbsp;Ella S. Sudit,&nbsp;Kathleen C. Gunthert,&nbsp;Nathaniel R. Herr","doi":"10.1016/j.beth.2025.01.007","DOIUrl":"10.1016/j.beth.2025.01.007","url":null,"abstract":"<div><div>Anger is intricately linked to symptoms of depression and has implications for functioning outcomes in romantic couples. There is a lack of research on whether symptoms of depression influence empathic accuracy of anger in couples, as well as whether perceptions of anger impact relationship quality for both partners. Using daily diary data, we examined these outcomes among 79 cohabitating couples (<em>n</em> = 158). Participants completed a baseline survey assessing relationship satisfaction and depression, as well as daily surveys rating their mood, their perception of their partner’s mood, and relationship satisfaction and closeness. Results indicated that partners of individuals with higher depressive symptoms display empathic inaccuracy of anger. They evidenced a bias towards perceiving higher participant anger even when participants themselves report low levels of anger or low overall negative affect. Partner bias towards perceiving their partners as angry predicted poorer ratings of relationship satisfaction and closeness from both partner and participant perspectives. Findings suggest that for couples in which one individual struggles with symptoms of depression, empathic inaccuracy of anger or biased perception of anger may be a mechanism by which interpersonal dysfunction is maintained.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 866-877"},"PeriodicalIF":3.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Idionomic Network Analysis of Trichotillomania Treatment Processes: Gathering Group-Level and Individual-Level Insights to Inform a Personalized Therapeutic Framework","authors":"Mercedes G. Woolley,&nbsp;Baljinder K. Sahdra,&nbsp;Emily M. Bowers,&nbsp;Leila K. Capel,&nbsp;Michael P. Twohig,&nbsp;Michael E. Levin","doi":"10.1016/j.beth.2025.01.006","DOIUrl":"10.1016/j.beth.2025.01.006","url":null,"abstract":"<div><div>Trichotillomania, characterized by repetitive hair-pulling, leads to significant distress and impairment. Heterogeneity in symptom profiles challenges the effectiveness of treatment protocols for trichotillomania. Recent research endorses personalized treatment, emphasizing the assessment of biopsychosocial processes to tailor interventions more closely to the individual. This shift to a process-based, person-centered framework necessitates analytic methods capable of probing beyond nomothetic patterns to unveil nuanced individual-level processes. This study utilized Group Iterative Multiple Model Estimation (GIMME) to examine group-level and individual-level network dynamics as an initial step towards a process-based treatment framework for trichotillomania. Ecological momentary assessment data from 54 affected individuals were analyzed to identify shared patterns applicable at the group level and individual level for individualized treatment. Analysis revealed a nomothetic process dynamically related to cognitive fixation on the urge to pull. At the individual level, notable variability in network structures emerged. While centrality measures consistently identified the urge to pull as a pivotal process within GIMME individual-level networks, the influence of other processes differed considerably between individuals. Results indicate that despite some shared components, the heterogeneity within individual networks calls for customized treatment approaches, and the assessment of psychological process dynamics at the individual level. These insights support incorporating idionomic methods into the developmental stages of personalized interventions.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 851-865"},"PeriodicalIF":3.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissemination Trial of Provider Training of ACT-Enhanced Behavior Therapy for Trichotillomania: A Waitlist Controlled Study","authors":"Mercedes G. Woolley,&nbsp;Sarah E. Schwartz,&nbsp;Kate L. Morrison,&nbsp;Michael P. Twohig","doi":"10.1016/j.beth.2025.01.005","DOIUrl":"10.1016/j.beth.2025.01.005","url":null,"abstract":"<div><div>Trichotillomania is a psychiatric disorder characterized by recurrent hair-pulling, leading to distress and impairment. Despite the efficacy of habit reversal training (HRT) and ACT-enhanced behavior therapy (A-EBT), there is a significant knowledge gap among providers about evidence-based treatments. This study aimed to bridge this gap by evaluating the feasibility, acceptability, and effects of internet-delivered therapist training in A-EBT for trichotillomania. A randomized waitlist-controlled implementation trial was conducted with 119 licensed mental health providers assigned to either immediate training or waitlist cohorts. The immediate training group participated in a 1-day online workshop followed by 6 months of consultation. Compared to the waitlist cohort, the immediate training cohort showed significant improvements in knowledge of trichotillomania, its treatments, and self-efficacy in providing the therapy, which were maintained throughout the end of the consultation period. Behavioral outcomes indicated that the immediate training cohort was more likely to self-promote their ability to treat trichotillomania, leading to an increased caseload of clients with trichotillomania and other body-focused repetitive behaviors (BFRBs). Approximately one-third of providers in both groups began treating at least one client with trichotillomania or another BFRB during the training period. In conclusion, training providers in A-EBT for trichotillomania is feasible and effective in improving provider knowledge and self-efficacy, leading to more individuals receiving evidence-based care. Future research should explore long-term impacts on client outcomes and ways to further enhance training dissemination and implementation for trichotillomania and other BFRBs.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 3","pages":"Pages 648-665"},"PeriodicalIF":3.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety, Worry, and Difficulty Concentrating: A Longitudinal Examination of Concurrent and Prospective Symptom Relationships","authors":"Mary Blendermann,&nbsp;Rosanna Breaux,&nbsp;Eiko I. Fried,&nbsp;Kristin Naragon-Gainey,&nbsp;Lisa R. Starr,&nbsp;Jeremy Stewart,&nbsp;Bethany A. Teachman ,&nbsp;COVID-19 Mental Health Workgroup ,&nbsp;Lauren S. Hallion","doi":"10.1016/j.beth.2025.01.004","DOIUrl":"10.1016/j.beth.2025.01.004","url":null,"abstract":"<div><div>Difficulty concentrating is an understudied cognitive phenomenon, despite its status as a diagnostic criterion for generalized anxiety disorder and contributor to clinically significant distress and impairment. Worry may constitute a cognitive mechanism by which anxiety leads to difficulty concentrating. The present study examined concurrent and prospective associations between self-reported anxiety, worry, and subjective difficulty concentrating across three timepoints (T1 April/May, T2 July/August, T3 October/November 2020) in 198 adults (<em>M</em> age = 37.94, <em>SD</em> = 13.42; 81% women, 2% gender minority) drawn from a larger study of trajectories of psychopathology during the COVID-19 pandemic. In multilevel models, anxiety was associated with worry both between (<em>β</em> = 0.65, <em>SE</em> = 0.13) and within participants (<em>β</em> = 0.12, <em>SE</em> = 0.11). Difficulty concentrating was also associated with worry between (<em>β</em> = 0.38, <em>SE</em> = 0.03) and within participants (<em>β</em> = 0.09, <em>SE</em> = 0.02). In a structural equation model, worry partially mediated the longitudinal association between anxiety and difficulty concentrating, though this effect was nonsignificant after controlling for difficulty concentrating at T2 and worry, depression, sleep disturbance, and difficulty concentrating at T1. The unadjusted mediation and these other findings are in line with theoretical accounts of worry as a cognitive mechanism linking anxiety to subjective attentional problems.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 838-850"},"PeriodicalIF":3.4,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the Role of Homework Compliance in Acceptance-Enhanced Behavior Therapy for Trichotillomania","authors":"Kathryn E. Barber,&nbsp;Douglas W. Woods,&nbsp;Michael P. Twohig,&nbsp;Stephen M. Saunders,&nbsp;Scott N. Compton,&nbsp;Martin E. Franklin","doi":"10.1016/j.beth.2025.01.003","DOIUrl":"10.1016/j.beth.2025.01.003","url":null,"abstract":"<div><div>Between-session therapy homework is a key component of cognitive-behavioral therapies, yet its role in trichotillomania treatment remains understudied. The present study examined the associations between homework compliance and treatment outcomes in acceptance and commitment therapy (ACT) enhanced behavior therapy (AEBT) for trichotillomania. Participants included 35 adults with trichotillomania who participated in a 12-week randomized controlled trial of AEBT. Therapists documented patient homework assignment completion and rated homework adherence after each session. Trichotillomania symptom severity was assessed posttreatment and at 6-month follow-up. Higher overall homework completion rate and therapist-rated homework adherence predicted lower trichotillomania symptom severity at posttreatment and follow-up. These findings were consistent for homework compliance during early and late treatment phases and for both ACT and behavior therapy–based homework assignments. A stronger therapeutic relationship strengthened the positive effects of homework compliance on symptom reduction. Higher automatic pulling moderated the association between overall homework completion and better outcomes. Predictors of higher homework compliance included higher therapeutic relationship quality, younger age, and lower anxiety. These findings underscore the importance of between-session homework in trichotillomania treatment and support the inclusion of both ACT and behavior therapy assignments. Interventions to promote homework compliance could enhance the efficacy of AEBT and lead to greater symptom improvements.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 823-837"},"PeriodicalIF":3.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concentrated Cognitive-Behavior Therapy for Unmedicated Children and Adolescents With Obsessive-Compulsive Disorder in Routine Clinical Care: A Randomized Controlled Trial With a 6-Month Naturalistic Follow-up","authors":"Laura Hermida-Barros,&nbsp;Blanca García-Delgar,&nbsp;Sara Lera-Miguel,&nbsp;Eduard Forcadell,&nbsp;Elena Moreno,&nbsp;Mireia Primé-Tous,&nbsp;Núria Jaurrieta,&nbsp;Xavier Segú,&nbsp;Enric Vilajosana,&nbsp;Carles Soriano-Mas,&nbsp;Lorena Fernández de la Cruz,&nbsp;Eduard Vieta,&nbsp;Joaquim Radua,&nbsp;Luisa Lázaro,&nbsp;Miquel A. Fullana","doi":"10.1016/j.beth.2025.01.001","DOIUrl":"10.1016/j.beth.2025.01.001","url":null,"abstract":"<div><div>Cognitive-behavior therapy (CBT) is effective for obsessive-compulsive disorder (OCD). Because CBT requires significant time and resources, there is an increased interest in developing shorter formats of CBT for OCD (i.e., fewer sessions or in less time). We conducted a randomized single-blind controlled trial to investigate the effectiveness of concentrated CBT (co-CBT; 20 hours of therapist time across one month) compared to a waiting list (WL) in 30 unmedicated children and adolescents with OCD aged 7–17 in routine clinical care. Co-CBT was superior to the WL in reducing OCD symptom severity at posttreatment (primary endpoint; Cohen’s <em>d</em> = 1.76) and these results were maintained through the end of a naturalistic 6-month follow-up. Participants initially randomized to the WL were offered co-CBT at the end of the trial and post-hoc analyses showed that they had similar improvements to those initially randomized to co-CBT. In post-hoc predictor analyses, participants aged 7–12, compared to those aged 13–17, and those with higher baseline OCD severity showed better posttreatment outcomes. Co-CBT is an effective intervention for unmedicated children and adolescents with OCD in routine clinical care. Studies including more robust control groups and larger samples are needed to replicate and expand these findings. Trial registration number: NCT04042038.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 799-811"},"PeriodicalIF":3.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between the Therapeutic Alliance and Social Anxiety Symptoms Along the Course of Internet-Delivered Cognitive Behavioral Treatment","authors":"Jonathan G. Shalom,&nbsp;Adi Prihar,&nbsp;Asher Y. Strauss,&nbsp;Jonathan D. Huppert,&nbsp;Gerhard Andersson,&nbsp;Idan M. Aderka","doi":"10.1016/j.beth.2025.01.002","DOIUrl":"10.1016/j.beth.2025.01.002","url":null,"abstract":"<div><div>The therapeutic alliance is a consistent predictor of treatment outcome. In the present study, we examined whether the therapeutic alliance is associated with symptoms of social anxiety along the course of internet-delivered cognitive behavior therapy (ICBT) for social anxiety disorder (SAD). We examined data from a large treatment trial (<em>n</em> = 182) in which individuals with SAD reported on their social anxiety and alliance with the therapist each week during the treatment (for 11 weeks). We examined the total variance in alliance as well as within- and between-individual variances separately. Consistent with our hypotheses, we found that the total variance in alliance predicted the total variance in social anxiety in the following week. In addition, we found that within-individual variance in alliance was negatively associated with within-individual variance in social anxiety (in the following week). Thus, weekly increases in alliances were associated with weekly reductions in social anxiety in the following week. Finally, we found that between-individual variance in alliance was positively associated with between-individual variance in social anxiety such that individuals who were more socially anxious created stronger alliances with their therapists over the course of treatment. Our findings suggest that the therapeutic alliance is important in ICBT for SAD, that separating variance into within and between components may help identify different psychological processes, and that improving within-individual alliance may lead to reductions in symptoms of social anxiety.</div></div>","PeriodicalId":48359,"journal":{"name":"Behavior Therapy","volume":"56 4","pages":"Pages 812-822"},"PeriodicalIF":3.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144312876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}