Holmqvist Rolf, Ström Thomas, Foldemo Anniqa
Rolf Holmqvist, Ph.D., Department of Behavioral Sciences and Learning, Linköping University , Sweden.
Nord J Psychiatry. 2014 Apr;68(3):204-12. doi: 10.3109/08039488.2013.797023. Epub 2013 Jun 13.
Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess.
The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences.
The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations-directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors.
Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients' motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment.
Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.
基于实践的研究发现，心理治疗在常规护理中有显著效果，不同治疗方法的效果往往相当。评估可能影响治疗效果的因素或许很重要。
本研究旨在评估初级保健中心理治疗的效果，并比较最常用方法之间的治疗效果。另一个目的是研究可能影响效果差异的因素。
采用常规评估临床结果（CORE）系统对瑞典初级保健中心的心理治疗进行评估。治疗方法由治疗师在治疗后进行编码。比较了三种主要治疗取向——指导性（认知、行为和认知行为疗法）、反思性（心理动力学和关系性）和支持性疗法。将患者和治疗师变量作为治疗调节因素进行研究。
对70名治疗师提供的733次治疗的分析显示，短期心理治疗（中位数疗程数 = 6）效果良好。43%的患者症状缓解，34%的患者康复。接受至少五次治疗的患者，这两个数字分别为50%和40%。指导性疗法和反思性疗法的效果相当，且优于支持性治疗。接受支持性治疗的患者年龄较大，接受的治疗疗程较少。治疗后治疗师评定，接受支持性治疗的患者的动机、联盟能力和反思能力较低。
初级保健中的心理治疗取得了良好效果。应更系统地研究支持性疗法，特别是关于可能影响治疗效果的变量。
