Spitzer Carsten, Barnow Sven, Freyberger Harald J, Grabe Hans Joergen
Department of Psychiatry and Psychotherapy, Ernst-Moritz-Arndt-University, Stralsund, Germany.
Aust N Z J Psychiatry. 2007 Aug;41(8):682-7. doi: 10.1080/00048670701449146.
Previous research has indicated that dissociation might be a negative predictor of treatment outcome in cognitive behavioural therapy for patients with obsessive-compulsive and anxiety disorders. Using a naturalistic design it was hypothesized that higher levels of dissociation predict poorer outcome in inpatients with affective, anxiety and somatoform disorders participating in a brief psychodynamic psychotherapy.
A total of 133 patients completed the Symptom Check List (SCL-90), the German short version of the Dissociative Experiences Scale and the Inventory of Interpersonal Problems at the beginning and the end of treatment. The Global Severity Index (GSI) of the SCL-90 was chosen as outcome criterion.
A total of 62.4% of study participants were classified as treatment responders, that is, they showed a statistically significant change of their GSI scores. Controlling for general psychopathology, the non-responders had significantly higher baseline dissociation scores than the responders. In a logistic regression analysis with non-response as a dependent variable, a comorbid personality disorder, low baseline psychopathology and high dissociation levels emerged as relevant predictors, but interpersonal problems and other comorbid disorders did not.
Dissociation has a negative impact on treatment outcome. It is suggested that dissociative subjects dissociate as a response to negative emotions arising in psychotherapy leading to a less favourable outcome. Additionally, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Thus, dissociation may directly and indirectly influence the treatment process and outcome.
先前的研究表明，分离可能是强迫症和焦虑症患者认知行为治疗中治疗结果的负面预测指标。采用自然主义设计，研究假设在参与简短心理动力心理治疗的情感障碍、焦虑症和躯体形式障碍住院患者中，较高水平的分离预示着较差的治疗结果。
共有133名患者在治疗开始和结束时完成了症状自评量表（SCL - 90）、德语简短版分离体验量表和人际问题量表。选择SCL - 90的总体严重程度指数（GSI）作为结果标准。
共有62.4%的研究参与者被归类为治疗反应者，即他们的GSI分数有统计学上的显著变化。在控制了一般精神病理学因素后，无反应者的基线分离分数显著高于反应者。在以无反应为因变量的逻辑回归分析中，共病的人格障碍、低基线精神病理学和高分离水平是相关的预测因素，但人际问题和其他共病障碍不是。
分离对治疗结果有负面影响。研究表明，具有分离特质的个体将分离作为对心理治疗中产生的负面情绪的反应，从而导致较差的治疗结果。此外，具有分离特质的患者可能有不安全的依恋模式，对治疗关系产生负面影响。因此，分离可能直接和间接地影响治疗过程和结果。
