A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, ßs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.

Gambling Behavior and Risk Factors in Preadolescent Students: A Cross Sectional Study.

Although gambling was initially characterized as a specific phenomenon of adulthood, the progressive lowering of the age of onset, combined with earlier and increased access to the game, led researchers to study the younger population as well. According to the literature, those who develop a gambling addiction in adulthood begin to play significantly before than those who play without developing a real disorder. In this perspective, the main hypothesis of the study was that the phenomenon of gambling behavior in this younger population is already associated with specific characteristics that could lead to identify risk factors. In this paper, are reported the results of an exploratory survey on an Italian sample of 2,734 preadolescents, aged between 11 and 14 years, who replied to a self-report structured questionnaire developed ad hoc. Firstly, data analysis highlighted an association between the gambling behavior and individual or ecological factors, as well as a statistically significant difference in the perception of gambling between preadolescent, who play games of chance, and the others. Similarly, the binomial logistic regression performed to ascertain the effects of seven key variables on the likelihood that participants gambled with money showed a statistically significant effect for six of them. The relevant findings of this first study address a literature gap and suggest the need to investigate the preadolescent as a cohort in which it identifies predictive factors of gambling behavior in order to design effective and structured preventive interventions.

Group analytic therapy for eating disorders: preliminary results in a single-group study.

OBJECTIVES: There is a lack of empirical data on the effectiveness and process of group-analytic therapy in eating disorders. This single-group study aimed to explore the effectiveness of such treatment for anorexic and bulimic individuals. METHOD: Eight patients (three anorexic and five bulimic women) entered group-analytic treatment, meeting weekly for 2 years. Eating behaviours, overall psychological distress and group process variables were regularly assessed using quantitative and qualitative measures, with comparisons made at the beginning and end of the therapy. RESULTS: Treatment was discontinued in two cases. When outcome was classified on the basis of reliable change and clinical significance for the remaining patients at the end of treatment, four were recovered in terms of overall psychological distress, while one was unchanged and one had deteriorated. In terms of eating disorder symptoms, three patients were recovered, two were unchanged and one had deteriorated. Patients experienced an overall positive group climate and a positive group alliance. Perception of being understood by the therapist appeared to play an important role in the therapeutic process. CONCLUSIONS: These preliminary results suggest that group-analytic therapy may be effective in helping patients with eating disorders. However, more work is needed before firm conclusions can be drawn. Implications for clinical practice and future research are discussed.

The factorial structure of the Outcome Questionnaire-45: a study with an Italian sample.

In this article, the authors study the factorial structure of the Italian translation of the Outcome Questionnaire 45 (OQ-45) in a sample of college students (n = 522) and psychiatric outpatients (n = 301). The relative goodness of fit of six competing models of the OQ-45 was examined using confirmatory factor analysis (CFA). Specifically, the study examined the relative fit of the most frequently presented models in the literature and three alternative models. Results of the CFA provided support for the four factor bi-level solution, suggesting that the OQ-45 is a multidimensional instrument that contains one general factor and multiple unique subscale factors.

Relation of the real relationship and the working alliance to the outcome of brief psychotherapy.

In this study, the (a) association of the client- and therapist-rated strength of the real relationship to the outcome of brief psychotherapy, and (b) extent to which the real relationship predicted outcome above and beyond the predictive power of the working alliance were examined. A total of 50 clients at the counseling center of a university in Italy received brief therapy and completed measures before treatment, after the third session, and at the end of treatment. From the clients' perspective, both the Genuineness element of the real relationship and the Bond scale of the working alliance were found to relate significantly to treatment outcome. When we examined the real relationship and working alliance as predictors in a hierarchical regression format, the client-rated real relationship, especially the Genuineness element, did predict outcome and, moreover, added significantly and substantially to the working alliance in predicting outcome. Neither the strength of the real relationship from the therapist's perspective nor the therapist-rated working alliance was found to relate to outcome. The findings are discussed in the context of methodological differences with other investigations of the real relationship.

[The outcome questionnaire 45.2. Italian validation of an instrument for the assessment of psychological treatments]. / L'Outcome questionnaire 45.2. Adattamento italiano di uno strumento per la valutazione dei trattamenti psicologici.

AIMS: The Outcome Questionnaire (OQ-45.2; Lambert et al., 2004) was designed to measure important areas of functioning (symptoms, interpersonal problems and social role functioning) that are of central interest in mental health. The cross-cultural validity of the OQ-45.2 in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and normative scores of the Italian OQ with the original American version. METHOD: Data were collected at university (N = 461), in community (N = 61) and in three mental health care organisations (N = 301). RESULTS: Results showed that the psychometric properties of the Italian OQ were adequate and similar to the original instrument. The CFA supported the multidimentional construct system of the instrument. Furthermore, normative scores were different for the Italian and American samples and this resulted in different cutoff scores for estimating clinically significant change in the Italian population. CONCLUSIONS: The Italian version of the OQ-45.2 appears promising as a measure of general psychological distress, and it could be used to measure the psychotherapy outcome in routine clinical practice.