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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3002 — Treatment Expectations, Compensation-Seeking Status, and Therapeutic Alliance in a Sample of Military Veterans with PTSD

Belsher BE (Palo Alto University; VA Medical Center, Washington, D.C.), Tiet QQ (National Center for PTSD, VA Palo Alto Health Care System), Garvert D (National Center for PTSD, VA Palo Alto Health Care System), Rosito O (Palo Alto University; National Center for PTSD, VA Palo Alto Health Care System), Joyce E (Palo Alto University), Rosen CS (National Center for PTSD, VA Palo Alto Health Care System)

Objectives:
(1) Explore the relationship between treatment expectations and therapeutic alliance in a sample of Veterans diagnosed with PTSD, (2) determine whether compensation-seeking status influences perceptions of the therapeutic alliance, (3) examine whether compensation-seeking moderates the relationship between treatment expectations and therapeutic alliance.

Methods:
319 Veterans (median age = 55) entering residential trauma programs completed a baseline assessment as part of a larger research protocol. This questionnaire included the Working Alliance Inventory (WAI), a question on participants’ disability compensation status for PTSD, and questions on participants' outcome expectations for treatment. Regression analyses were conducted to examine the hypotheses.

Results:
Results indicated a significant and positive main effect between treatment expectations and therapeutic alliance (b = .292; p < .001), with expectations accounting for 9% of the variance (F (1, 178) = 15.565; p < .001). When compensation-seeking status was included in the regression, there was a significant interaction between treatment expectations and compensation-seeking status on therapeutic alliance (b = -.622; p < .05). Further analyses indicated that for Veterans not seeking compensation, there was a strong relationship between treatment expectations and alliance, with expectations explaining 25% of the variance of alliance (b = .503, F (1, 42) = 14.21; p < .001). For Veterans seeking compensation, there was a weaker relationship between treatment expectations and alliance, with expectations accounting for only 6% of the variance (b = .250, F (1, 134) = 8.90; p < .01).

Implications:
In line with previous literature, patients with higher treatment outcome expectations tended to report a stronger alliance with their treatment providers. Compensation status moderated the relationship between treatment expectations and alliance. For Veterans seeking PTSD-related compensation, expectations are not as predictive of the therapeutic alliance, as compared with Veterans not seeking disability compensation.

Impacts:
Veterans seeking additional disability compensation may have multiple goals in seeking treatment. Therapeutic alliance may depend not only on patient expectations that treatment can improve their functioning but also other factors, such as beliefs that participating in treatment can support their disability claims.


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