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Published Online: 10 January 2024

Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating

Elizabeth B. Ruzicka, Ph.D. [email protected], Lauren B. Shomaker, Ph.D., Laura Pyle, Ph.D., Jennifer L. Bakalar, Ph.D., Lisa M. Shank, Ph.D., M.P.H., Ross D. Crosby, Ph.D., Denise E. Wilfley, Ph.D., Jami F. Young, Ph.D., Tracy Sbrocco, Ph.D., Sheila M. Brady, M.S.N., Lauren D. Gulley, Ph.D., Jack A. Yanovski, M.D., Ph.D., and Marian Tanofsky-Kraff, Ph.D.Authors Info & Affiliations
Publication: American Journal of Psychotherapy
Volume 77, Number 1
https://doi.org/10.1176/appi.psychotherapy.20230011
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Abstract

Objective:

Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes.

Methods:

Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12–17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator.

Results:

Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05).

Conclusions:

The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.

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Information & Authors

Information

Published In

Go to American Journal of Psychotherapy
Go to American Journal of Psychotherapy
American Journal of Psychotherapy
Volume 77 • Number 1 • March 15, 2024
Pages: 7 - 14
PubMed: 38196343

History

Received: 21 March 2023
Revision received: 14 July 2023
Revision received: 23 September 2023
Accepted: 11 October 2023
Published online: 10 January 2024
Published in print: March 15, 2024

Keywords

  1. Therapeutic alliance
  2. Interpersonal psychotherapy
  3. Loss of control
  4. Child/adolescent psychiatry
  5. Depressive disorders
  6. Feeding and eating disorders

Authors

Affiliations

Elizabeth B. Ruzicka, Ph.D. [email protected]
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Lauren B. Shomaker, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Laura Pyle, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Jennifer L. Bakalar, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Lisa M. Shank, Ph.D., M.P.H.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Ross D. Crosby, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Denise E. Wilfley, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Jami F. Young, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Tracy Sbrocco, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Sheila M. Brady, M.S.N.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Lauren D. Gulley, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Jack A. Yanovski, M.D., Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Marian Tanofsky-Kraff, Ph.D.
Department of Human Development and Family Studies, Colorado State University, Fort Collins (Ruzicka, Shomaker, Gulley); Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora (Ruzicka, Shomaker, Pyle, Gulley); Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda (Bakalar, Shank, Sbrocco, Tanofsky-Kraff); Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda (Shank, Brady, Yanovski, Tanofsky-Kraff); Department of Biomedical Statistics and Methodology, Neuropsychiatric Research Institute, Fargo, North Dakota (Crosby); Department of Psychology, Washington University in St. Louis, St. Louis (Wilfley); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia (Young); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Young).
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Notes

Send correspondence to Dr. Ruzicka ([email protected]).
Some of these data were presented at the annual meeting of The Obesity Society, San Diego, November 1–4, 2022.

Competing Interests

Dr. Crosby reports being a paid statistical consultant for Health Outcomes Solutions. Dr. Young reports receiving royalties from Oxford University Press for a book that informed the intervention reported in this article and receiving financial compensation for training and consultation on this intervention and related interventions. The other authors report no financial relationships with commercial interests.

Funding Information

Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (1-R01-DK-080906 to Dr. Tanofsky-Kraff), the USUHS (R-072-IC to Dr. Tanofsky-Kraff), and NICHD (ZIA-HD-00641 to Dr. Yanovski).These views represent the opinions of the authors and not necessarily those of the Commissioned Corps of the U.S. Public Health Service, the U.S. Department of the Navy, the USUHS, or the U.S. government.

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