Alliance-Outcome Associations in Interventions for Youth Internalizing Disorders: Identifying Mediators and Moderators 

Suboptimal treatment response rates in interventions for youth internalizing disorders (anxiety, depression, OCD) highlight a critical need to enhance intervention outcomes. This dissertation project addresses this need by identifying therapeutic process variables that predict intervention outcomes, and examining how, for whom, and under what circumstances they contribute to outcomes.

In a series of three studies, I present findings on a systematic review and meta-analysis of alliance-outcome associations in youths receiving intervention for internalizing disorders (Study 1) and examine variables that may explain or influence alliance-outcome associations in interventions for internalizing problems in university-based (Study 2) and usual care settings (Study 3). Findings across studies revealed that (1) findings on alliance-outcome associations are mixed and may be explained by clinical and methodological heterogeneity between studies; (2) age influences the association between therapeutic alliance and outcome, with stronger effects in older youths compared to younger youths; (3) session attendance is important to outcome; and (4) associations between early provider perceptions of alliance and outcomes may be more complex than previously believed.

Findings from the three studies provide a more nuanced understanding of alliance-outcome associations in interventions for youth internalizing disorders. Future research should consider the role of additional engagement variables on outcomes, evaluate why early provider perceptions of alliance might predict worse youth outcomes in cognitive behavioral therapy, and incorporate developmental considerations into models of youth engagement and outcomes. 

Major Professor: Dr. Jeremy Pettit