Testing the Alliance and Cognitive Change as Simultaneous Processes of Change in Cognitive Therapy for Anxiety

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.

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BibTeX RIS

BibTeX

@misc{barnhill2026testing,
  title = {{Testing the Alliance and Cognitive Change as Simultaneous Processes of Change in Cognitive Therapy for Anxiety}},
  author = {Alexandra K. Barnhill and Madeline Kushner and Doug Terrill and Matthew W. Southward},
  howpublished = {PsyArXiv},
  year = {2026},
  month = sep,
  doi = {10.31234/osf.io/35htu_v2},
  url = {https://osf.io/preprints/psyarxiv/35htu_v2/},
  note = {CC BY 4.0},
}

RIS

TY  - UNPB
TI  - Testing the Alliance and Cognitive Change as Simultaneous Processes of Change in Cognitive Therapy for Anxiety
AU  - Alexandra K. Barnhill
AU  - Madeline Kushner
AU  - Doug Terrill
AU  - Matthew W. Southward
PY  - 2026
DA  - 2026/09/04
PB  - PsyArXiv
DO  - 10.31234/osf.io/35htu_v2
UR  - https://osf.io/preprints/psyarxiv/35htu_v2/
AB  - 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.
ER  -

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