{
  "abstract": "Researchers have proposed that both a strong working alliance and cognitive change are key processes of change in cognitive therapy for emotional disorders. Schmidt et al. (2019) demonstrated that within-person cognitive change occurring between sessions mediated the relation between within-person cognitive change in the previous session and subsequent depression improvement. We conducted a conceptual replication and extension of Schmidt et al. (2019) in a sample of adults with elevated anxiety (N = 200; Mage = 32.1; 78% female, 80% White, 73% heterosexual) who completed self-report measures before and after four sessions of cognitive therapy. Using dynamic structural equation modeling, we replicated Schmidt et al.’s (2019) results that between-session cognitive change (CC-S) mediated the relation between in-session cognitive change (CC-I) and depression improvement (ODSIS; B = –.16, p < .01) and extended them to improvements in anxiety (OASIS; B = –.18, p < .01). We also found that between-session cognitive change mediated the relation between the working alliance (WAI-SR) and anxiety and depression improvement (Bs: –.12 - –.11, ps < .01). The indirect effects involving cognitive change did not significantly differ from those involving the total alliance and agreement on the tasks of therapy, ps > .15, but were stronger than those involving agreement on the goals of therapy and the therapeutic bond, ps < .03. Both the alliance and cognitive change may be key processes of change, albeit at different steps in the overall pathway, in cognitive therapy for emotional disorders.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "Alexandra K. Barnhill"
    },
    {
      "name": "Madeline Kushner"
    },
    {
      "name": "Doug Terrill"
    },
    {
      "name": "Matthew W. Southward"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c216p51b9b7kn.bib",
  "cited_by": 0,
  "doi": "10.31234/osf.io/35htu_v2",
  "fulltext_url": null,
  "id": "c216p51b9b7kn",
  "issns": [],
  "landing_url": "https://osf.io/preprints/psyarxiv/35htu_v2/",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "bepress",
      "Anxiety Disorders"
    ],
    [
      "bepress",
      "Clinical Psychology"
    ],
    [
      "bepress",
      "Intervention Research"
    ],
    [
      "bepress",
      "Psychotherapy"
    ],
    [
      "bepress",
      "Social and Behavioral Sciences"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://osf.io/35htu/download",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c216p51b9b7kn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:26:06Z",
      "native_id": "35htu",
      "source": "osf",
      "url": "https://osf.io/preprints/psyarxiv/35htu_v2/"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "bepress:Clinical Psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Testing the Alliance and Cognitive Change as Simultaneous Processes of Change in Cognitive Therapy for Anxiety",
  "title_text": "Testing the Alliance and Cognitive Change as Simultaneous Processes of Change in Cognitive Therapy for Anxiety",
  "type": "preprint",
  "updated_at": "2026-10-30T12:26:06Z",
  "url": "https://research.draconitic.com/paper/c216p51b9b7kn",
  "venue": "PsyArXiv",
  "versions": []
}