Davidson Kate, Livingstone Steven, McArthur Katherine, Dickson Lindsay, Gumley Andrew
Department of Psychological Medicine, University of Glasgow, UK.
Psychol Psychother. 2007 Dec;80(Pt 4):513-23. doi: 10.1348/147608307X191535.
Integrative complexity (IC), a measure of cognitive style, was used to analyse discourse in Cognitive Behaviour Therapy (CBT) sessions from patients with borderline personality disorder treated in the BOSCOT trial. It was predicted that patients' level of integrative complexity would be positively associated with the outcome of therapy. That is, an increase in patients' level of integrative complexity would be associated with good outcome. We also predicted that therapists would also show an increase in the level of complexity associated with their patient's increase in integrative complexity and good outcome.
Ten patients who received CBT were categorized according to the outcome, good (N=5) and poor (N=5), using an algorithm that incorporated the number of suicide attempts and magnitude of change in severity of depression during therapy.
For each patient and their therapist, an early and a late therapy session were transcribed and coded for integrative complexity (IC) (N=20 sessions transcribed). IC scores for patients and therapists were compared across early and late therapy sessions and for good and poor outcomes of therapy.
The majority of discourse was at the lower levels of IC. Higher levels of IC at baseline were related to depression and anxiety. Good outcome was not associated with a change in the level of IC between earlier and later CBT sessions. Therapists, however, showed an increase in IC when patient's outcome was poor. In addition, an increase in patient's IC was associated with improvement in social functioning.
Therapists may overcompensate for patient's poor outcome by giving more complex explanations to patients. Higher complexity does not necessarily lead to better outcomes.
整合复杂性（IC）是一种认知风格的度量指标，用于分析在BOSCOT试验中接受治疗的边缘型人格障碍患者的认知行为疗法（CBT）疗程中的话语。研究预测，患者的整合复杂性水平将与治疗结果呈正相关。也就是说，患者整合复杂性水平的提高将与良好的治疗结果相关。我们还预测，治疗师的复杂性水平也会随着患者整合复杂性的提高和良好的治疗结果而增加。
使用一种结合自杀未遂次数和治疗期间抑郁严重程度变化幅度的算法，将10名接受CBT治疗的患者根据治疗结果分为良好（N = 5）和不良（N = 5）两类。
对每位患者及其治疗师，转录并编码一次早期和一次晚期治疗疗程的整合复杂性（IC）（共转录20个疗程）。比较患者和治疗师在早期和晚期治疗疗程中的IC得分，以及治疗结果的好坏。
大多数话语的IC水平较低。基线时较高的IC水平与抑郁和焦虑有关。良好的治疗结果与早期和晚期CBT疗程之间IC水平的变化无关。然而，当患者治疗结果不佳时，治疗师的IC水平会增加。此外，患者IC的增加与社交功能的改善有关。
治疗师可能会通过向患者提供更复杂的解释来过度补偿患者不佳的治疗结果。更高的复杂性不一定会带来更好的治疗结果。
