Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptomreduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy(web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists.Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients andtherapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings;and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion.Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eatingdisorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder nototherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping AllianceQuestionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclasscorrelations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists.A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predictedeating disorder pathology and therapy completion.Results: For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients andtherapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreasedsignificantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightlybetter after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatmentwere associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patientscores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulnessscores of therapists were positively associated with treatment completion.Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Ofparticular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predictingposttreatment eating disorder pathology and treatment completion.
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In honours programmes, teachers face the task of designing courses in which students feel challenged and learn from accomplishing demanding assignments. The aim of this study was to investigate students’ and teachers’ perceptions of challenge and learning in an honours programme. From 2016 to 2019, students and teachers rated the learning activities during the programme and explained their ratings. The results showed that in the first two years, teachers estimated challenge and learning significantly higher than the students did. However, both students and teachers viewed the tasks as the factor with the strongest impact on challenge and learning. In the first year, students also identified group dynamics as challenging and a source for learning. Enhancing task complexity and supporting group dynamics are the main factors to adjust the level of challenge in an honours programme. Monitoring students’ and teachers’ perceptions can help to adapt the programme to improve students’ learning.
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We examined the neural correlates of facial attractiveness by presenting pictures of male or female faces (neutral expression) with low/intermediate/high attractiveness to 48 male or female participants while recording their electroencephalogram (EEG). Subjective attractiveness ratings were used to determine the 10% highest, 10% middlemost, and 10% lowest rated faces for each individual participant to allow for high contrast comparisons. These were then split into preferred and dispreferred gender categories. ERP components P1, N1, P2, N2, early posterior negativity (EPN), P300 and late positive potential (LPP) (up until 3000 ms post-stimulus), and the face specific N170 were analysed. A salience effect (attractive/unattractive > intermediate) in an early LPP interval (450–850 ms) and a long-lasting valence related effect (attractive > unattractive) in a late LPP interval (1000–3000 ms) were elicited by the preferred gender faces but not by the dispreferred gender faces. Multi-variate pattern analysis (MVPA)-classifications on whole-brain single-trial EEG patterns further confirmed these salience and valence effects. It is concluded that, facial attractiveness elicits neural responses that are indicative of valenced experiences, but only if these faces are considered relevant. These experiences take time to develop and last well beyond the interval that is commonly explored.
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