University of Freiburg, Department of Psychosomatic Medicine and Psychotherapy, Freiburg, Germany.
Psychotherapy (Chic). 2010 Sep;47(3):355-70. doi: 10.1037/a0021166.
Treatment in bulimia nervosa is challenging, with rates of successful treatments for only about 50% of all patients. This study aimed to identify predictors of outcome through secondary analysis of data from a randomized clinical trial that compared inpatient and day hospital treatment for bulimia. Process measures included assessments of patients' in-session experiences, therapeutic alliance, and therapy-related intersession experiences (ISE). ISE measures were better predictors of outcome than pretreatment variables (e.g., social adjustment) or global therapeutic alliance. Outcome at 3 month follow-up was strongly related to the ISE dimension Recreating Therapeutic Dialogue with Negative Emotions, indicating a heightened risk of failure. Prediction of outcome by these variables showed a sensitivity of 0.86 and a specificity of 0.78, and 83% of patients could be correctly classified. These results show that certain aspects of ISE may serve as early and reliable indicators of long term treatment failure, prompting alternate treatment approaches and opening new directions of research.
治疗神经性贪食症具有挑战性，所有患者中只有约 50%的治疗取得成功。本研究旨在通过对一项比较住院和日间医院治疗神经性贪食症的随机临床试验数据进行二次分析，确定预后的预测因素。过程测量包括评估患者的治疗过程体验、治疗联盟和治疗相关的治疗间隙体验（ISE）。ISE 测量比治疗前变量（例如社会适应）或整体治疗联盟更好地预测预后。3 个月随访时的结果与 ISE 维度“重现与负面情绪的治疗对话”密切相关，表明失败风险较高。这些变量的预后预测具有 0.86 的敏感性和 0.78 的特异性，83%的患者可以被正确分类。这些结果表明，ISE 的某些方面可能是长期治疗失败的早期和可靠指标，促使采用替代治疗方法，并开辟新的研究方向。
