Common Change Factors and Mediation of the Alliance-Outcome Link During Treatment of Depression

Objective: Alliance, Mastery/Self-Efficacy, Problem Actualization, and Problem Clarification exemplify common or nonspecific factors of change in psychotherapy (Grawe, 1997). In this study, we tested the hypothesis that other change factors mediate the alliance-outcome link on a within-person level over the treatment course. Method: Our sample consisted of 193 patients with major depression undergoing intensive inpatient cognitive-behavioral-based therapy. Each week, we assessed depressive symptoms (using the Beck Depression Inventory-II) and change factors during individual therapy. Multilevel mediation models were used to test our hypothesis. Results: As expected, within-person change in Alliance (differentiated into Emotional Bond and Contentment with the Therapist) as well as Mastery/Self-Efficacy and Problem Clarification predicted symptom change over the course of therapy. Moreover, the relation between Contentment with the Therapist and subsequent change in depression was mediated by increased Mastery/Self-Efficacy on a within-person level. Conclusions: Our data suggest that within-person change of alliance and other general change factors precede symptom change in depressive patients, and that the link between alliance and outcome may be partially mediated by enhanced Mastery/Self-Efficacy. Future studies should further elucidate the mechanisms responsible for the alliance-outcome link.