Trial reportPsychotherapy and psychosomatics2015
Therapeutic alliance in antidepressant treatment: cause or effect of symptomatic levels?
Trial report in Psychotherapy and psychosomatics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review.Frontiers in psychiatry · 2019Pooled it
- A Machine Learning Approach to Identifying Placebo Responders in Late-Life Depression Trials.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2018Trial
- Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder.Journal of child and adolescent psychopharmacology · 2018Trial
- Pharmacotherapy for social anxiety disorder: Interpersonal predictors of outcome and the mediating role of the working alliance.Journal of anxiety disorders · 2017Trial
- Specific expectancies are associated with symptomatic outcomes and side effect burden in a trial of chamomile extract for generalized anxiety disorder.Journal of psychiatric research · 2017Trial
- Changes in causal attributions and relationship representations: Are they specific or common mechanisms in the treatment of depression?Journal of affective disorders · 2016Trial
- Therapist-reported alliance: Is it really a predictor of outcome?Journal of counseling psychology · 2015Trial
- Ingredients for Success: What Clients and Informal Caregivers Value in Depression Treatment A Concept Mapping Study.Journal of clinical psychology · 2026Article
- Creating a Therapeutic Alliance with Caregivers: An Introduction to Motivational Interviewing.Behavior analysis in practice · 2026Article
- The relevance of phenotypic definition in treatment resistant forms of major depressive disorder: a narrative review.Frontiers in pharmacology · 2026Review
- [Mechanisms of action of antidepressive pharmacotherapy: brain and mind-body and environment].Der Nervenarzt · 2025Review
- Placebo and the law of identification.Frontiers in psychiatry · 2024Article
- Therapeutic Relationships in Applied Behavior Analysis: Current Status and Future Directions.Behavior analysis in practice · 2023Article
- Proof of Concept of the Contribution of the Interaction between Trait-like and State-like Effects in Identifying Individual-Specific Mechanisms of Action in Biological Psychiatry.Journal of personalized medicine · 2022Article
- Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis.JMIR mental health · 2022Article
- Psychiatry in the Digital Age: A Blessing or a Curse?International journal of environmental research and public health · 2021Review
- What matters more? Common or specific factors in cognitive behavioral therapy for OCD: Therapeutic alliance and expectations as predictors of treatment outcome.Behaviour research and therapy · 2018Article
- Not Just Nonspecific Factors: The Roles of Alliance and Expectancy in Treatment, and Their Neurobiological Underpinnings.Frontiers in behavioral neuroscience · 2018Review
- Neural Substrate of Group Mental Health: Insights from Multi-Brain Reference Frame in Functional Neuroimaging.Frontiers in psychology · 2017Article
- New analytic strategies help answer the controversial question of whether alliance is therapeutic in itself.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundPrevious studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment.
methodsData from a psychopharmacological randomized controlled trial for the treatment of adult major depression (n = 42), including the patients' rating of the alliance with the physicians, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome.
resultsThe effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were observed. Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p = 0.008). The main limitation is the small cohort size.
conclusionsThe findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.