Stiles-Shields Colleen, Kwasny Mary J, Cai Xuan, Mohr David C
Department of Preventive Medicine.
J Consult Clin Psychol. 2014 Apr;82(2):349-54. doi: 10.1037/a0035554. Epub 2014 Jan 20.
Telephone-administered therapies have emerged as an alternative method of delivery for the treatment of depression, yet concerns persist that the use of the telephone may have a deleterious effect on therapeutic alliance. The purpose of this study was to compare therapeutic alliance in clients receiving cognitive behavioral therapy (CBT) for depression by telephone (T-CBT) or face-to-face (FtF-CBT).
We randomized 325 participants to receive 18 sessions of T-CBT or FtF-CBT. The Working Alliance Inventory (WAI) was administered at Weeks 4 and 14. Depression was measured during treatment and over 1 year posttreatment follow-up using the Hamilton Rating Scale for Depression and Patient Health Questionnaire-9.
There were no significant differences in client or therapist WAI between T-CBT or FtF-CBT (Cohen's f² ranged from 0 to .013, all ps > .05). All WAI scores predicted depression end of treatment outcomes (Cohen's f² ranged from .009 to .06, all ps < .02). The relationship between the WAI and depression outcomes did not vary by treatment group (Cohen's f² ranged from 0 to .004, ps > .07). The WAI did not significantly predict depression during posttreatment follow-up (all ps > .12).
Results from this analysis do not support the hypothesis that the use of the telephone to provide CBT reduces therapeutic alliance relative to FtF-CBT.
电话治疗已成为治疗抑郁症的一种替代治疗方式，但人们仍担心使用电话可能会对治疗联盟产生有害影响。本研究的目的是比较通过电话接受认知行为疗法（CBT）治疗抑郁症的患者（电话CBT）与面对面接受CBT治疗抑郁症的患者（面对面CBT）之间的治疗联盟情况。
我们将325名参与者随机分为接受18次电话CBT或面对面CBT治疗的两组。在第4周和第14周时使用工作联盟量表（WAI）进行评估。在治疗期间以及治疗后1年的随访中，使用汉密尔顿抑郁量表和患者健康问卷-9来测量抑郁情况。
电话CBT组和面对面CBT组在患者或治疗师的WAI得分上没有显著差异（科恩f²范围为0至0.013，所有p值均大于0.05）。所有WAI得分均预测了治疗结束时的抑郁结果（科恩f²范围为0.009至0.06，所有p值均小于0.02）。WAI与抑郁结果之间的关系在不同治疗组中没有差异（科恩f²范围为0至0.004，p值大于0.07）。WAI在治疗后随访期间对抑郁情况没有显著预测作用（所有p值均大于0.12）。
该分析结果不支持以下假设，即相对于面对面CBT，使用电话提供CBT会降低治疗联盟。
