Godfrey E, Chalder T, Ridsdale L, Seed P, Ogden J
Department of Psychology, Institute of Psychiatry, Kings College London, UK.
Br J Clin Psychol. 2007 Sep;46(Pt 3):253-72. doi: 10.1348/014466506X147420.
To develop a brief measure of the therapy process and use it to examine which therapeutic ingredients were associated with outcome in a sample of patients from a randomized controlled trial (RCT) of cognitive behaviour therapy (CBT) versus counselling for patients with chronic fatigue in primary care. It was hypothesized that the two therapies would be clearly distinguishable and that in terms of process variables, the therapeutic alliance would be important in predicting outcome.
The data for this study were collected alongside a RCT in primary care and included audiotaped therapy sessions. These tapes were assessed by two independent raters using a newly devised measure in order to evaluate therapy process and its relationship with outcome.
Tapes from 71 patients participating in the RCT were assessed to form the basis of the process analysis. Outcome was self-reported fatigue symptoms at 6 months follow-up. Data reduction was achieved via a principal component analysis (PCA). Factors were entered into a multiple regression analysis to produce a final model of predictors of outcome.
The process measure showed that although the treatments could be distinguished, there was some overlap between them. The key predictor of a good fatigue outcome was emotional processing, including the expression, acknowledgement and acceptance of emotional distress.
A new process measure was developed successfully which now warrants further testing. It was able to assess treatment adherence and unpack, and distinguish the common factor which predicted outcome across therapy modalities. The findings lend preliminary support to the view that the specific techniques associated with particular 'brand names' of therapy are not necessarily the 'active ingredients' that help patient's change within the primary care setting. Emotional processing predicted outcome for patients with chronic fatigue and therefore future research might explore this in more depth, in order to understand better how it can be facilitated.
开发一种简短的治疗过程测量方法，并使用它来检验在一项针对初级保健中慢性疲劳患者的认知行为疗法（CBT）与咨询的随机对照试验（RCT）样本中，哪些治疗要素与治疗结果相关。假设两种疗法能够清晰区分，并且就过程变量而言，治疗联盟在预测结果方面很重要。
本研究的数据是在一项初级保健RCT过程中收集的，包括治疗过程的录音。两名独立评估者使用一种新设计的测量方法对这些录音进行评估，以评估治疗过程及其与结果的关系。
对参与RCT的71名患者的录音进行评估，以形成过程分析的基础。结果是在6个月随访时自我报告的疲劳症状。通过主成分分析（PCA）实现数据降维。将因素纳入多元回归分析，以生成结果预测因子的最终模型。
过程测量表明，虽然两种治疗方法可以区分，但它们之间存在一些重叠。疲劳症状改善的关键预测因素是情绪处理，包括情绪困扰的表达、认知和接受。
成功开发了一种新的过程测量方法，现在需要进一步测试。它能够评估治疗依从性并剖析和区分跨治疗方式预测结果的共同因素。这些发现初步支持了这样一种观点，即在初级保健环境中，与特定“品牌”治疗相关的具体技术不一定是帮助患者改变的“有效成分”。情绪处理预测了慢性疲劳患者的治疗结果，因此未来的研究可能会更深入地探讨这一点，以便更好地理解如何促进情绪处理。
