Moleiro Carla, Beutler Larry E
ISCTE, Lisbon University Institute, Portugal.
J Affect Disord. 2009 May;115(1-2):220-4. doi: 10.1016/j.jad.2008.09.009. Epub 2008 Oct 11.
The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices.
In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336-352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285-299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted.
Findings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance.
Small sample sizes and representativeness of each treatment warrant further replication of these results.
Implications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.
变化评估一直是心理治疗研究中的一个难题，且在循证实践的兴起过程中变得越发重要。
在本文中，使用可靠变化指数[雅各布森，N.S.，福莱特，W.C.，雷文斯托夫，D.，1984年。心理治疗结果研究：报告变异性和评估临床意义的方法。行为疗法。15，336 - 352]和规范比较（等效性检验；[肯德尔，P.C.，马尔斯 - 加西亚，A.，纳特，S.R.，谢德里克，R.C.，1999年。评估临床意义的规范比较。咨询与临床心理学杂志。67，285 - 299]）分析了243名接受九种抑郁症治疗方法之一的患者变化的临床意义。第一种方法解决的问题是所发生的变化是否足够大，可归因于治疗而非测量误差，第二种方法解决的问题是将接受治疗个体的功能水平与非临床人群进行比较。因此，就九种抑郁症治疗方法的可靠性和临床意义进行了比较。还进行了治疗结果研究中的传统统计检验。
研究结果支持在心理治疗过程中分析变化临床意义的重要性。虽然除一种治疗方法外，所有治疗方法都导致抑郁症状有统计学上的显著变化，但在治疗方法的可靠性和临床意义方面发现了差异。
各治疗方法的样本量小和代表性需要进一步重复这些结果。
讨论了在探索心理治疗方法的实证支持时结合传统统计分析使用临床意义检验的意义，这对希望采用循证实践的临床医生将更有用且有意义。
