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The Course of the Working Alliance during Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder

Published online by Cambridge University Press:  17 October 2013

Irene Ngai ,
Erin C. Tully  and
Page L. Anderson
Irene Ngai
Affiliation:
Georgia State University, Atlanta, USA
Erin C. Tully
Affiliation:
Georgia State University, Atlanta, USA
Page L. Anderson*
Affiliation:
Georgia State University, Atlanta, USA
*
Reprint requests to Page Anderson, Department of Psychology, Georgia State University, PO Box 5010, Atlanta, Georgia 30302, USA. E-mail: panderson@gsu.edu
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Abstract

Background: Psychoanalytic theory and some empirical research suggest the working alliance follows a “rupture and repair” pattern over the course of therapy, but given its emphasis on collaboration, cognitive behavioral therapy may yield a different trajectory. Aims: The current study compares the trajectory of the working alliance during two types of cognitive behavioral therapy for social anxiety disorder – virtual reality exposure therapy (VRE) and exposure group therapy (EGT), one of which (VRE) has been proposed to show lower levels of working alliance due to the physical barriers posed by the technology (e.g. no eye contact with therapist during exposure). Method: Following randomization, participants (N = 63) diagnosed with social anxiety disorder received eight sessions of manualized EGT or individual VRE and completed a standardized self-report measure of working alliance after each session. Results: Hierarchical linear modeling showed overall high levels of working alliance that changed in rates of growth over time; that is, increases in working alliance scores were steeper at the beginning of therapy and slowed towards the end of therapy. There were no differences in working alliance between the two treatment groups. Conclusion: Results neither support a rupture/repair pattern nor the idea that the working alliance is lower for VRE participants. Findings are consistent with the idea that different therapeutic approaches may yield different working alliance trajectories.

Keywords

Social anxiety disorderworking alliancevirtual reality exposure therapyexposure group therapycognitive behavioral therapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 2 , March 2015 , pp. 167 - 181
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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