Markowitz John C, Kaplowitz Matthew, Suh Eun-Jung, Meehan Kevin B, Neria Yuval, Jonker Hanske, Rafaeli Alexandra, Lovell Karina
Department of Psychiatry, Columbia University.
J Nerv Ment Dis. 2012 Jul;200(7):594-7. doi: 10.1097/NMD.0b013e31825bfaf4.
Clinical trials of psychotherapy require diagnostic homogeneity, which implies a convergence of clinical presentations. Yet research study patients present diversely, and patients who do not fit a treatment paradigm may greatly complicate delivery of the study psychotherapy. The research literature has not addressed this issue. The authors use case illustrations of three psychotherapies--Prolonged Exposure, Relaxation Therapy, and Interpersonal Psychotherapy--from an ongoing psychotherapy outcome trial of posttraumatic stress disorder to describe psychotherapeutic responses to complex, "atypical" patients who strain standard treatment paradigms. Therapists required flexibility, and occasionally deviations from strict protocol, in treating heterodox patients. Such heterogeneity of presentation may have implications for psychotherapy outcome in research trials. Despite lack of discussion in the literature, many trials may face such issues.
心理治疗的临床试验需要诊断的同质性，这意味着临床表现的趋同性。然而，研究中的患者呈现出多样化的表现，那些不符合治疗范式的患者可能会极大地使研究性心理治疗的实施复杂化。研究文献尚未涉及这一问题。作者利用正在进行的创伤后应激障碍心理治疗结果试验中的三种心理治疗方法——延长暴露疗法、放松疗法和人际心理治疗——的案例说明，来描述对那些使标准治疗范式紧张的复杂“非典型”患者的心理治疗反应。治疗师在治疗非正统患者时需要灵活性，偶尔也要偏离严格的方案。这种表现的异质性可能会对研究试验中的心理治疗结果产生影响。尽管文献中缺乏相关讨论，但许多试验可能会面临此类问题。
