A model of purchase intention of complementary and alternative medicines: the role of social media influencers' endorsements.

BACKGROUND: Social Media Influencers (SMIs) are a fashionable way of marketing products by creating electronic word-of-mouth (e-WOM) on social media. The marketing of complementary and alternative medicines (CAMs) by SMIs is becoming increasingly popular and gaining credibility within consumers on social media platforms. Nonetheless, advising about healthcare products on social media should be examined as it is different from endorsing other kinds of commercial products. The aim of this study is to develop a model that provides the underlying mechanisms of the stimuli of SMIs on social media towards consumers' purchase intention of CAMs. METHODS: This study used best fit framework synthesis methods to develop the model. A priori theory selection was conducted by identifying a BeHEMoTh strategy (Behavior of Interest, Health context, Exclusions and Models or Theories) to systematically approach identifying relevant models and theories relative to the research aim. Further evidence derived from primary research studies that describe the behavior identified is coded against selected a priori theory to develop the model. RESULTS: This study presents a novel model for understanding the purchase behavior of CAMs using SMIs as a marketing strategy. The model included two well-known theories (theory of planned behaviour theory and source credibility theory) as well as extensive existing research from a multidisciplinary perspective. The model is exclusively designed to help identify elements affecting perceived source credibility and factors that have an influence over consumers' preferences to purchase CAMs by taking into consideration SMIs' endorsements. CONCLUSIONS: This study provides unique insights introducing new research areas to health literature and offers, new roles for healthcare professionals in this digital era by gaining new skills and competencies required to provide more credible and accurate information about CAMs. The study also highlights the new marketing era of online health-related product endorsements and recommends that policymakers and researchers carefully evaluate the impact of SMI's on the use of CAMs, as well as to regulate the content of these promotional materials.

Political news on Instagram: influencer versus traditional magazine and the role of their expertise in consumers' credibility perceptions and news engagement.

Introduction: Social networking sites (SNS) are increasingly used by consumers to read and share political news. In this context, Instagram plays an important role due to its prevalence and visual characteristics. However, previous research has highlighted that consumers fail to identify the source of online news, though source characteristics were shown to be vital for news credibility perceptions. Nevertheless, research on whether and which source characteristics have an influence on Instagram consumers' credibility perceptions and news engagement intentions are lacking. The present study addresses this empirical gap by investigating potential effects of source expertise and source type on source credibility, message credibility, news engagement intentions, and personal involvement regarding political news on Instagram. Method: We randomly presented participants with political news posts from one of four sources, either the Instagram representation of a fictional news magazine or influencer with or without political expertise. Participants assessed the perceived credibility of the source and the news, their news engagement intentions, and personal involvement. Results: We analyzed data from 416 participants. Results showed significant main effects of source expertise on each of the dependent variables. Those were shown to be indirect effects through personal involvement. There were hardly any effects of source type. Discussion: These results provide new insights into the role of source expertise on credibility perceptions and news engagement intentions, and provide insights into the comparison between influencers and Instagram representations of traditional news magazines. Theoretical implications for future research and practical implications for content creators, users, and SNS platforms are discussed.

Effect of visual imagery in COVID-19 social media posts on users' perception.

People receive a wide variety of news from social media. They especially look for information on social media in times of crisis with the desire to assess the risk they face. This risk assessment, and other aspects of user reactions, may be affected by characteristics of the social media post relaying certain information. Thus, it is critical to understand these characteristics to deliver information with the reactions in mind. This study investigated various types of imagery used as thumbnails in social media posts regarding news about the COVID-19 pandemic. In an experimental design, 300 participants viewed social media posts containing each of the three types of imagery: data visualization (directly about risk information), advisory (not containing direct risk information, but instead help on how to lower risk), or clickbait (containing no risk-related information, just generic visuals). After observing the social media posts, they answered questionnaires measuring their emotions (valence, arousal, and dominance), risk perception, perceived credibility of the post, and engagement. The participants also indicated their emotions towards and interest in COVID-19 news coverage, age, gender, and how often and actively they use social media. These variables acted as controls. The data were analysed using mixed linear models. Results indicated that advisory imagery positively influenced valence, arousal, dominance, credibility, and (lower) risk perception. Alternatively, imagery showing data visualizations yielded low valence, arousal, dominance, credibility, and high risk perception. Clickbait-styled thumbnails which carry no information are usually measured between the other two types. The type of imagery did not affect the motivation to engage with a post. Aside from visual imagery, most variables were affected by COVID sentiment and the usual activity on social media. These study results indicate that one should use advisory imagery for more comfortable news delivery and data visualization when the poster wishes to warn users of existing risks.

PSR-FCCLP model based total maximum allocated loads optimization of TN and TP in Bohai Bay.

Eutrophication is a global problem for coastal ecosystems, one that Bohai Bay, China, has been severely afflicted due to rapid economic and social development in the past decades. It was urgent to manage the total maximum allocated loads (TMALs) of the total nitrogen (TN) and total phosphorus (TP) on land-based, which was closely related to coastal eutrophication. In this study, from the perspective of economy-resources-environment (ERE) system, we presented the fuzzy credibility constrained linear programming based on pressure-state-response (PSR-FCCLP) model, which calculated the TMALs of TN and TP at three credibility levels (λ = 0.55, 0.75, and 0.95) in Bohai Bay. The results showed that when the credibility level increased from 0.55 to 0.95, the TMALs of TN and TP would decrease from 13,573.38 t/a to 12,820.00 t/a and from 2665.58 t/a to 2514.90 t/a, respectively. This study will provide support for environmental management in coastal regions.

Do You Mind? Examining the Impact of Psychoeducation Specificity on Perceptions of Mindfulness-Based Programs.

OBJECTIVE: Mindfulness-based programs (MBPs) cultivate the capacity for mindfulness, defined as nonjudgmental acceptance and awareness of present-moment experience. Mindfulness has been associated with a host of benefits for users, such as improved indices of mental well-being. We examined public perceptions of acceptability (i.e., how appropriate the treatment is for a given problem) and credibility (i.e., how logical and convincing a treatment seems) of MBPs as a form of mental health intervention. The main objective of this study was to examine whether higher specificity of psychoeducational content improved perceptions of the acceptability and credibility of MBPs. METHODS: Participants (n = 188; female% = 39.4) were recruited online and randomly assigned to one of two conditions. In one condition, participants received balanced and evidence-based psychoeducation specific to MBPs for mental health. In the other condition, participants received general information about psychological treatments for mental health. Acceptability and credibility perceptions were measured by questionnaires across time (pre-and post-psychoeducation) and across specificity conditions (specific vs. general psychoeducation). RESULTS: Participants randomized to the general, but not the specific, psychoeducation-endorsed higher scores of acceptability of MBPs post-psychoeducation. Further, participants endorsed higher scores of MBP credibility post-psychoeducation, regardless of the specificity of psychoeducation provided. CONCLUSIONS: Perceptions of the acceptability of MBPs were improved following exposure to general psychoeducation, and perceptions of the credibility of MBPs were improved following psychoeducation, regardless of specificity. Examining public perceptions of MBPs is important for informing strategies to support access to and use of MBPs.

Does Health Literacy Make a Difference? Comparing the Effect of Conventional Medicine Versus Homeopathic Prescribing on Treatment Credibility and Expectancy.

OBJECTIVE: While homeopathic remedies are often used to treat non-specific complaints such as headaches, empirical evidence suggests their treatment effect is due to the placebo effect. Low health literacy seems to be connected to higher use of complementary and alternative medicine (CAM). The aim of this study was to examine what people with occasional headaches expect from conventional medicine or homeopathic remedies and if health literacy interacts with this expectation. METHODS: In this experimental study, n = 582 participants with occasional headaches were randomized to read one of two vignettes, which described the prescription of either conventional medicine or a homeopathic remedy. Subsequently, the participants were asked to rate treatment credibility and expectancy with regard to their assigned vignette. Health literacy was assessed as a potential moderator. RESULTS: Participants in the conventional medicine group rated treatment credibility and expectancy higher than in the homeopathic remedy group. Moderation analysis revealed that when being offered conventional medicine, participant reports of treatment credibility and expectancy decreased with lower health literacy, while these outcomes increased with lower health literacy for homeopathic remedies. DISCUSSION: People with occasional headaches estimate the effectiveness of conventional medication properly. However, health care professionals should pay special attention to patients with low health literacy, as they might need more time and information to give their informed consent.

Osteopathic medicine for fibromyalgia: a sham-controlled randomized clinical trial.

BACKGROUND: Patients with fibromyalgia (FM) frequently resort to osteopathic or chiropractic treatment, despite very weak supporting evidence. We aimed to assess the efficacy of osteopathic manipulation in FM in a properly controlled and powered randomized clinical trial. METHODS: Patients were randomized to osteopathic or sham treatment. Treatment was administered by experienced physical medicine physicians, and consisted of six sessions per patient, over 6 weeks. Treatment credibility and expectancy were repeatedly evaluated. Patients completed standardized questionnaires at baseline, during treatment, and at 6, 12, 24, and 52 weeks after randomization. The primary outcome was pain intensity (100-mm visual analog scale) during the treatment period. Secondary outcomes included fatigue, functioning, and health-related quality of life. We performed primarily intention-to-treat analyses adjusted for credibility, using multiple imputation for missing data. RESULTS: In total, 101 patients (94% women) were included. Osteopathic treatment did not significantly decrease pain relative to sham treatment (mean difference during treatment: -2.2 mm; 95% confidence interval, -9.1 to 4.6 mm). No significant differences were observed for secondary outcomes. No serious adverse events were observed, despite a likely rebound in pain and altered functioning at week 12 in patients treated by osteopathy. Patient expectancy was predictive of pain during treatment, with a decrease of 12.9 mm (4.4-21.5 mm) per 10 points on the 0-30 scale. Treatment credibility and expectancy were also predictive of several secondary outcomes. CONCLUSION: Osteopathy conferred no benefit over sham treatment for pain, fatigue, functioning, and quality of life in patients with FM. These findings do not support the use of osteopathy to treat these patients. More attention should be paid to the expectancy of patients in FM management.

Visualizing pathogens: Disfluent shapes of pathogens increase their perceived complexity and danger while realism and disfluency boost the credibility of visualizations.

During the COVID-19 pandemic, the public was regularly presented with visualizations of the viral pathogen causing this disease. Since there are several ways of visually communicating information, we investigate whether different types of visualizations affect how viewers judge the credibility of information as well as the complexity and potential harm of pathogens. A first experiment was conducted to assess whether a round, fluent shape elicits a different response than pathogens featuring disfluent components such as thread-like appendages. Visualizations of disfluent bacteria were rated as more credible than those of fluent bacteria. In Experiment 2, bacteria were either presented as realistic renderings or as cartoon-like line drawings (varied between-subjects). Furthermore, half of the six bacteria had fluent shapes, while the other half featured disfluent shapes, resulting in the within-subjects factor of fluency. Participants were asked to rate the credibility, complexity, and risk of serious illness associated with these bacteria. We found that disfluent bacteria were perceived as having a more complex metabolism and as holding a higher risk for serious illness. Furthermore, realism and disfluent shapes increase the credibility of visualizations, but not the credibility of additional information. These results have important implications for the field of science communication.

Aloe vera and health outcomes: An umbrella review of systematic reviews and meta-analyses.

This umbrella review aims to summarize the effects of Aloe vera on health outcomes and assess the strength of evidence. PubMed, Scopus, Embase, Cochrane database of systematic reviews, CINAHL, and AMED were searched from inception to October, 2019 for systematic reviews and meta-analyses of clinical trials that investigated the effects of Aloe vera on health outcomes. Two independent reviewers extracted data, assessed the methodological quality, and rated the credibility of evidence according to established criteria. Ten articles reporting 71 unique outcomes of Aloe vera were included. Of these, 47 (67%) were nominally statistically significant based on random-effects model (p ≤ .05). Only 3 outcomes were supported by highly suggestive evidence, whereas 42 outcomes were supported by weak evidence. The highly suggestive evidence supported benefits of Aloe vera in the prevention of second-degree infusion phlebitis (RR: 0.18, 95% CI: 0.10-0.32, p-value: 1.75 × 10-9 ) and chemotherapy-induced phlebitis based on overall incidence (OR: 0.13, 95% CI: 0.08-0.20, p-value: 9.68 × 10-20 ) and incidence of the second degree of severity (OR: 0.10, 95% CI: 0.07-0.14, p-value: 3.41 × 10-35 ). However, the majority of the evidence were limited by small sample size and poor methodological quality. Therefore, despite the overall favorable effect of Aloe vera, more robust studies are needed.

Consumer intention to purchase GM soybean oil in China: effects of information consistency and source credibility.

Consumers' potential reactions toward genetically modified (GM) foods affect their commercial feasibility and determine the decisions of economic agents. Inconsistent information on GM foods has created a sense of uncertainty in Chinese consumers' mind. This paper studies how the information about risks and benefits of GM foods from major sources influences Chinese consumer intention to purchase GM soybean oil. This analysis uses data from a survey of 880 residents randomly sampled from 13 cities in Jiangsu province. Using a multinomial logit model, we analyze the effects of information consistency and source credibility. The results show because of new information about 17.36% of consumers increase their intention to purchase GM soybean oil, and 15.10% of consumers decrease purchase intention. Compared to consistent information, inconsistent information can maximize change of purchase intention. The attitude change is greatest when there is a moderate difference between the new information and the initial consumer attitude. Furthermore, trust in biotechnology research institutes, government departments about GM, and GM experts are easier to promote consumers to change their intention to purchase GM soybean oil in a positive direction. Finally, we discuss implications for agencies as to strengthening the regulation and supervision of information sources, and including public-involved policies.Abbreviations: GM, Genetically modified; GMOs, Genetically modified organisms; AGGMO, Center of Agriculture's Genetically Modified Organisms' safety management and policy research organization at Nanjing Agricultural University; MARA, Ministry of Agriculture and Rural Affairs; ¥1 (RMB)≈$6.8 (USD).

Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care.

The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.

Credible practice of modeling and simulation in healthcare: ten rules from a multidisciplinary perspective.

The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model's credibility, they cannot be assumed to equate to a holistic credible practice, which includes activities that can impact comprehension and in-depth examination inherent in the development and reuse of the models. For the past several years, the Committee on Credible Practice of Modeling and Simulation in Healthcare, an interdisciplinary group seeded from a U.S. interagency initiative, has worked to codify best practices. Here, we provide Ten Rules for credible practice of modeling and simulation in healthcare developed from a comparative analysis by the Committee's multidisciplinary membership, followed by a large stakeholder community survey. These rules establish a unified conceptual framework for modeling and simulation design, implementation, evaluation, dissemination and usage across the modeling and simulation life-cycle. While biomedical science and clinical care domains have somewhat different requirements and expectations for credible practice, our study converged on rules that would be useful across a broad swath of model types. In brief, the rules are: (1) Define context clearly. (2) Use contextually appropriate data. (3) Evaluate within context. (4) List limitations explicitly. (5) Use version control. (6) Document appropriately. (7) Disseminate broadly. (8) Get independent reviews. (9) Test competing implementations. (10) Conform to standards. Although some of these are common sense guidelines, we have found that many are often missed or misconstrued, even by seasoned practitioners. Computational models are already widely used in basic science to generate new biomedical knowledge. As they penetrate clinical care and healthcare policy, contributing to personalized and precision medicine, clinical safety will require established guidelines for the credible practice of modeling and simulation in healthcare.

Does patient expectancy account for the cognitive and clinical benefits of mindfulness training in older adults?

OBJECTIVES: Patient expectations of treatment effects could influence neuropsychological and clinical outcomes in clinical trials of behavioral and lifestyle interventions, which could potentially confound the interpretation of findings. Our aim was to examine whether patient expectancy mediated effectiveness of Mindfulness-Based Stress Reduction (MBSR) for improving cognitive function and clinical outcome. METHODS: The present study uses data from a single-blind, multi-site, randomized controlled trial comparing MBSR to a health education attention control in older adults with anxiety and/or depressive disorders and subjective cognitive concerns. Using the Credibility and Expectations Questionnaire, we measured expectancy and perceived credibility of the interventions assigned to patients. Using mediational analysis, we examined the influence of expectancy and credibility on two key outcomes: memory performance and clinical global improvement. RESULTS: Neither expectancy nor perceived credibility of intervention accounted significantly for MBSR's effectiveness for memory test performance or clinical global improvement. CONCLUSION: In this clinical trial, expectancy for improvement did not account for the effectiveness of MBSR on memory performance or clinical outcomes in depressed and anxious older adults. We advise that clinical trials of behavioral and lifestyle interventions for brain health in older adults should measure and test the role of expectancy.

Assessing Children's Credibility in Courtroom Investigations of Alleged Child Sexual Abuse: Suggestibility, Plausibility, and Consistency.

As children's testimonies of child sexual abuse (CSA) often lack concrete evidence to corroborate a child's claims, attorneys devote a substantial amount of time to establishing a child as credible during the course of a trial. Examining 134 CSA victim testimonies for children aged 5-17 (M = 12.48, SD = 3.34; 90% female), we explored how attorneys assess child credibility through specifically targeting children's suggestibility/honesty, plausibility, and consistency. Results revealed that while prosecutors examine plausibility more often to establish credibility, defense attorneys focus their assessments on suggestibility/honesty and potential inconsistency. However, both attorneys asked many more questions about children's consistency than any other area of potential credibility. Furthermore, while prosecutors ask proportionally more credibility-challenging questions of older children, the defense do not. These results suggest that prosecutors may be missing an opportunity to establish children as honest and consistent and elucidate a need to train attorneys on the implications of children's inconsistencies, suggestibility, and plausible abuse dynamics.

Attacking science on social media: How user comments affect perceived trustworthiness and credibility.

The science on controversial topics is often heatedly discussed on social media, a potential problem for social-media-based science communicators. Therefore, two exploratory studies were performed to investigate the effects of science-critical user comments attacking Facebook posts containing scientific claims. The claims were about one of four controversial topics (homeopathy, genetically modified organisms, refugee crime, and childhood vaccinations). The user comments attacked the claims based on the thematic complexity, the employed research methods, the expertise, or the motivations of the researchers. The results reveal that prior attitudes determine judgments about the user comments, the attacked claims, and the source of the claim. After controlling for attitude, people agree most with thematic complexity comments, but the comments differ in their effect on perceived claim credibility only when the comments are made by experts. In addition, comments attacking researchers' motivations were more effective in lowering perceived integrity while scientists' perceived expertise remained unaffected.

Differential Influence of Acupuncture Somatosensory and Cognitive/Affective Components on Functional Brain Connectivity and Pain Reduction During Low Back Pain State.

The underlying mechanism of pain reduction by acupuncture is still unclear, because acupuncture treatment involves multidimensional factors. In this study, we investigated the differential influence of acupuncture components on brain functional connectivity and on pain reduction. We used a specific form of sham acupuncture (phantom acupuncture; PHNT), which only has a needling-credibility (a belief that they were treated with real acupuncture needles), while real acupuncture (REAL) has a somatosensory needling stimulation, as well as a needling-credibility. Forty-three patients with low back pain were randomized into the REAL group (n = 25) and the PHNT group (n = 18). They underwent two pain steady-state fMRI runs implemented by a low back extension (LBE) pain model (lifting the low back using air-cuff inflation) before and after REAL or PHNT stimulation. Subjective pain ratings, perceived throughout the LBE runs due to the posture, were reported (LBEpain). The regions of interest (ROI) were (1) the main nodes of the default mode network (DMN) - the medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), (2) the main nodes of the salience network (SN) - the anterior/posterior insular cortices (a/pINS), and (3) the low back-specific region of sensorimotor network (SMN), S1back. Significant reductions in LBEpain were observed in both groups (REAL = -1.02 ± 1.53, PHNT = -1.26 ± 2.20). In REAL group, decreased LBEpain was positively correlated with decreased functional connectivity between the mPFC and pINS (r = 0.58, P < 0.05). Reduced LBEpain in PHNT was negatively correlated with increased PCC-aINS connectivity (r = -0.48, P < 0.05) and tended toward positive correlation with decreased S1back-pINS connectivity (r = 0.44, P = 0.07). Our findings might suggest different brain mechanisms of observed pain reduction; REAL seems to involve detachment of the self from the sensory aspect of pain, while PHNT does to shift attention to self and disengages physical pain processing hubs. This exploratory study proposes a sham methodology to dissociate the influence of different acupuncture components in acupuncture research. Further studies need to be followed with more elaborated hypothesis, study design, and analysis considering various cognitive/affective factors for better understanding of brain mechanisms of pain reduction regarding the different acupuncture aspects.

Treatment credibility, expectancy, and preference: Prediction of treatment engagement and outcome in a randomized clinical trial of hatha yoga vs. health education as adjunct treatments for depression.

BACKGROUND: Hatha yoga may be helpful for alleviating depression symptoms. The purpose of this analysis is to determine whether treatment program preference, credibility, or expectancy predict engagement in depression interventions (yoga or a control class) or depression symptom severity over time. METHODS: This is a secondary analysis of a randomized controlled trial (RCT) of hatha yoga vs. a health education control group for treatment of depression. Depressed participants (n = 122) attended up to 20 classes over a period of 10 weeks, and then completed additional assessments after 3 and 6 months. We assessed treatment preference prior to randomization, and treatment credibility and expectancy after participants attended their first class. Treatment "concordance" indicated that treatment preference matched assigned treatment. RESULTS: Treatment credibility, expectancy, and concordance were not associated with treatment engagement. Treatment expectancy moderated the association between treatment group and depression. Depression severity over time differed by expectancy level for the yoga group but not for the health education group. Controlling for baseline depression, participants in the yoga group with an average or high expectancy for improvement showed lower depression symptoms across the acute intervention and follow-up period than those with a low expectancy for improvement. There was a trend for a similar pattern for credibility. Concordance was not associated with treatment outcome. LIMITATIONS: This is a secondary, post-hoc analysis and should be considered hypothesis-generating. CONCLUSIONS: Results suggest that expectancy improves the likelihood of success only for a intervention thought to actively target depression (yoga) and not a control intervention.

Changing beliefs about past public events with believable and unbelievable doctored photographs.

Doctored photographs can shape what people believe and remember about prominent public events, perhaps due to their apparent credibility. In three studies, subjects completed surveys about the 2012 London Olympic torch relay (Experiment 1) or the 2011 Royal Wedding of Prince William and Kate Middleton (Experiments 2-3). Some were shown a genuine photo of the event; others saw a doctored photo that depicted protesters and unrest. A third group of subjects saw a doctored photo whose inauthenticity had been made explicit, either by adding a written disclaimer (Experiment 1) or by making the digital manipulation deliberately poor (Experiments 2-3). In all three studies, doctored photos had small effects on a subset of subjects' beliefs about the events. Of central interest though, comparable effects also emerged when the photos were overtly inauthentic. These findings suggest that cognitive mechanisms other than credibility - such as familiarity misattribution and mental imagery - can rapidly influence beliefs about past events even when the low credibility of a source is overt.

Predictors of premature termination from psychotherapy for anorexia nervosa: Low treatment credibility, early therapy alliance, and self-transcendence.

OBJECTIVE: Failure to complete treatment for anorexia nervosa (AN) is- common, clinically concerning but difficult to predict. This study examines whether therapy-related factors (patient-rated pretreatment credibility and early therapeutic alliance) predict subsequent premature termination of treatment (PTT) alongside self-transcendence (a previously identified clinical predictor) in women with AN. METHODS: 56 women aged 17-40 years participating in a randomized outpatient psychotherapy trial for AN. Treatment completion was defined as attending 15/20 planned sessions. Measures were the Treatment Credibility, Temperament and Character Inventory, Vanderbilt Therapeutic Alliance Scale and the Vanderbilt Psychotherapy Process Scale. Statistics were univariate tests, correlations, and logistic regression. RESULTS: Treatment credibility and certain early patient and therapist alliance/process subscales predicted PTT. Lower self-transcendence and lower early process accounted for 33% of the variance in predicting PTT. DISCUSSION: Routine assessment of treatment credibility and early process (comprehensively assessed from multiple perspectives) may help clinicians reduce PTT thereby enhancing treatment outcomes.