***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The contribution to outcome of two group-process factors , group cohesion and group therapeutic alliance , was tested in the context of a r and omized , controlled treatment trial for borderline personality disorder . Group members from four time-limited groups of an experimental model of group psychotherapy  completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy . Outcome was measured in terms of psychiatric symptoms , social adaptation , and indicators of behavioral dysfunction . The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures . Stepwise regression analyses showed , however , that when compared with cohesion , alliance accounted for more outcome variance on the dependent measures . The clinical implication s of the findings and the limitations of the study are discussed BACKGROUND It is widely assumed that the outcome of correctional treatment largely depends on the patient 's treatment engagement ; however , evidence for this notion is scarce . AIM In this study , the  Treatment Engagement Rating scale ( TER ) was used to investigate the relationship of a patient 's treatment engagement with premature treatment termination and treatment outcome , defined as reduction of the risk of reoffending . METHOD Employing a prospect i ve design , this study addressed the relationship of the behavioural treatment engagement of correctional out patients ( N = 138 ) with treatment non-completion and treatment outcome , respectively . RESULTS Treatment engagement as measured by the TER emerged as an accurate predictor of treatment non-completion ( area under the curve = 0.76 ; odds ratio = 4.1 ) and was also significantly correlated with treatment outcome ( rho = 0.41 ) . The prediction was more accurate for sex offenders than for violent offenders , for expulsion from the treatment than for dropout , and when treatment engagement was assessed closer to the end of the treatment . CONCLUSIONS The study provides evidence that the outcome of correctional treatment depends to a substantial degree on the behavioural efforts that the patients make for the treatment . Periodic assessment of treatment engagement in correctional treatment facilities would be useful , and the TER seems to be a practical , reliable and valid instrument for this purpose The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients . In the outpatient sample , ratings of the working alliance , whether provided by the client or therapist , were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods , after a variety of other sources of variance were controlled . Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes . Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up . The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic out patients The bidirectional causal relationships between psychotherapy homework ( HW ) compliance and changes in depression were assessed in 2 groups of depressed out patients treated with cognitive-behavioral therapy  using nonrecursive structural equation modeling techniques . The data were consistent with the hypothesis that HW compliance had a causal effect on changes in depression , and the magnitude of this effect was large . Patients who did the most HW improved much more than patients who did little or no HW . In contrast , depression severity did not appear to influence HW compliance . HW compliance did not appear to be a proxy for any other , unobserved ( 3rd ) variable , such as motivation . Although the causal effect of HW on depression was large , the correlation between HW and depression was small . Some possible explanations , along with suggestions for future studies , are proposed We present a brief measure of awareness of illness in schizophrenia and test whether awareness is related to perceived need for and adherence to outpatient psychiatric treatment . A prospect i ve design assessed treatment adherence , awareness of the signs and symptoms of schizophrenia , symptoms , neurocognitive status , and substance abuse at baseline and 6-month follow-up in 89 persons with schizophrenia . Results indicate that persons with greater awareness perceived greater need for outpatient treatment and evidence d better adherence to outpatient treatment when adherence and awareness were measured concurrently . Awareness was not related to adherence at 6-month follow-up . In addition , neurocognitive impairment was associated with lower overall adherence to treatment when reported by collaterals at baseline and 6-month follow-up . Neurocognitive impairment was , however , associated with higher self-reported adherence to medication , which suggests that neurocognitive status may bias adherence reporting in persons with schizophrenia OBJECTIVE The authors extend previous research on homework in psychotherapy by examining the relationship between homework compliance and therapeutic outcome among depressed older adult out patients ( N = 63 ) , addressing previous limitations by using session-by-session therapist ratings of homework compliance and including both interviewer ratings and patient self-reports of outcomes . METHODS Patients were participants in a r and omized clinical trial evaluating the efficacy of desipramine versus cognitive/behavioral therapy-alone ( C/B-Alone ) versus a combination of the two ( Combined ) . Given the current study 's focus on homework compliance , only patients assigned to conditions with assigned homework in the clinical trial ( i.e. , C/B-Alone and Combined conditions ) were included . RESULTS Results of hierarchical regression analyses indicated that homework compliance contributed significantly to posttreatment outcome as measured by both interviewer-administered and patient self-report measures of depression . A separate series of ANOVAs also found significant differences in pre-posttreatment change between patients scoring above and below the median of reported homework compliance . Findings were similar for patients in the C/B-Alone and Combined conditions . CONCLUSION The study 's results call for additional research on issues related to homework compliance with older adult patients This paper reports on the development and initial psychometric evaluation of the Treatment Adherence Survey-patient version ( TAS-P ) , a brief instrument design ed to assess patient adherence to Cognitive-Behavioral Therapy ( CBT ) and pharmacotherapy recommendations for OCD . Eighty individuals with Obsessive Compulsive Disorder ( OCD ) were administered the TAS-P as part of the intake interview of a prospect i ve , observational study of the course of OCD . Results demonstrated excellent test-retest reliability . Responses on the TAS-P were also significantly correlated with scores on a self-report measure of general treatment adherence and with data collected from a chart- review , demonstrating concurrent validity . Treatment adherence was not explained by demographic variables . However , participants who reported nonadherence to CBT recommendations had more severe OCD symptoms at the time of intake than those who did not endorse CBT nonadherence ( mean Y-BOCS = 23.27 + /- 7.5 versus 18.20 + /- 8.0 , respectively ) . Results suggest that the TAS-P is a promising instrument for assessing reasons for nonadherence to recommendations for CBT and pharmacotherapy interventions The purpose of this study was to examine the comparative efficacy of cognitive rehabilitation as an intervention for substance misuse . Patients with substance use disorders entering long-term residential care ( N = 160 ) were r and omly assigned to one of two conditions : ( a ) st and ard treatment plus computer-assisted cognitive rehabilitation ( CACR ) , which was design ed to improve cognitive performance in areas such as problem solving , attention , memory , and information processing speed ; and ( b ) an equally intensive attention control condition consisting of st and ard treatment plus a computer-assisted typing tutorial ( CATT ) . Participants were assessed at baseline , during treatment , at treatment completion , and 3- , 6- , 9- , and 12-month follow-up . Intent-to-treat analyses showed that , compared with those r and omized to CATT , patients who received CACR were significantly more engaged in treatment ( e.g. , higher ratings of positive participation by treatment staff , higher ratings of therapeutic alliance ) , more committed to treatment ( e.g. , longer stays in residence ) and reported better long-term outcomes ( e.g. , higher percentage of days abstinent after treatment ) . Mediational analyses revealed the positive comparative effect of  CACR on abstinence during the year after treatment was mediated by treatment engagement and length of stay in residence 
    Output:
    
Although our findings suggest that therapeutic engagement appears to be considered an important construct to assess , they also reveal that there is little consensus in the definition of engagement employed .
It is concluded that further work is required to develop adequate measures of therapeutic engagement