Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

While Cognitive-Behavioural Therapy (CBT) has been well established as an effective treatment for anxiety, non-response to treatment is a common occurrence. Alliance ruptures (AR), or deteriorations in the relationship between client and therapist, have been shown to be a critical factor limiting therapeutic progress, relating negatively to retention and treatment outcomes. Despite increasing recommendations to enhance therapist awareness of ARs, very little is known about how aware CBT therapists are of ARs, and whether this awareness is related to CBT outcomes. Given their strong predictive capacity, together with evidence suggesting that therapists have tremendous difficulty navigating negative interpersonal process, there is strong empirical support for exploring therapist awareness of ARs as a means of improving treatment outcomes in CBT. The proposed project aims to evaluate therapist awareness of client-identified ARs (measured by significant drops in client ratings of the therapeutic alliance from one session to the next) in the context of 55 clients receiving 15 sessions of CBT for generalized anxiety disorder. Therapists also made session-by-session ratings of the alliance. Therapist accuracy (or discrepancy) in detecting drops in client-rated alliance will be related to short-term (e.g., homework compliance) and long-term (e.g., diagnostic status, self-reported worry) treatment outcomes. This is the first study to examine therapist awareness of ARs, and if successful, has major potential to inform public health interventions to enhance therapist awareness of key problems in the therapeutic alliance as a first step to improving CBT adherence and outcomes. Finally, by disseminating results to academic and applied settings, this project has the capacity to inform training and clinical-decision making in CBT, serving to bridge the gap between knowledge and practice.