Spinhoven Philip, Giesen-Bloo Josephine, van Dyck Richard, Arntz Arnoud
Department of Psychology and Psychiatry, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
J Clin Psychol. 2008 Jun;64(6):667-86. doi: 10.1002/jclp.20466.
Surprisingly few studies have investigated the accuracy of prognostic assessments of therapy outcome by clinicians. The objective of the present study was to investigate the relationship between clinicians' prognostic assessments and patient characteristics and treatment outcome. Seventy-one patients with a borderline personality disorder randomly allocated to schema-focused therapy (SFT) or transference-focused psychotherapy (TFP) were assessed every 3 months for 3 years. Prognostic assessments proved to be unrelated to patients' biographical (i.e., age, gender, education level, and employment level) and clinical characteristics (i.e., number of Axis I and Axis II diagnoses, and severity of psychiatric symptoms or borderline personality pathology). Clinical assessors as well as therapists rated the probability of success for SFT to be higher than for TFP. Prospective assessments of assessors and therapists accurately predicted different indices of outcome above and independent of patient characteristics. The prediction of outcome in the TFP condition in particular proved to be valid. Identifying prognostic markers of treatment outcome as used by clinicians in their prognostic assessments may improve current prediction models and patient-treatment matching.
令人惊讶的是，很少有研究调查临床医生对治疗结果进行预后评估的准确性。本研究的目的是调查临床医生的预后评估与患者特征及治疗结果之间的关系。71名边缘性人格障碍患者被随机分配到图式聚焦疗法（SFT）或移情聚焦心理治疗（TFP）组，在3年时间里每3个月进行一次评估。结果表明，预后评估与患者的个人经历（即年龄、性别、教育水平和就业水平）以及临床特征（即轴I和轴II诊断的数量，以及精神症状或边缘性人格病理的严重程度）无关。临床评估者和治疗师都认为SFT成功的可能性高于TFP。评估者和治疗师的前瞻性评估准确地预测了不同的结果指标，且独立于患者特征。特别是在TFP条件下对结果的预测被证明是有效的。识别临床医生在预后评估中使用的治疗结果预后标志物，可能会改善当前的预测模型和患者与治疗的匹配度。
