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增强型认知行为疗法治疗神经性贪食症中的治疗联盟:可能是必要的,但肯定是不够的。

Therapeutic alliance in Enhanced Cognitive Behavioural Therapy for bulimia nervosa: probably necessary but definitely insufficient.

机构信息

Centre for Clinical Interventions, 223 James St, Northbridge, Western Australia 6003, Australia.

Centre for Clinical Interventions, 223 James St, Northbridge, Western Australia 6003, Australia; School of Psychology, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.

出版信息

Behav Res Ther. 2014 Jun;57:65-71. doi: 10.1016/j.brat.2014.04.004. Epub 2014 May 4.

Abstract

The present paper assessed therapeutic alliance over the course of Enhanced Cognitive Behavioural Therapy (CBT-E) in a community-based sample of 112 patients with a diagnosis of bulimia nervosa (BN) or atypical BN. Temporal assessment of alliance was conducted at three time points (the start, middle and end of treatment) and the relationship between alliance and treatment retention and outcome was explored. Results indicated that the alliance between patient and therapist was strong at all stages of CBT-E, and even improved in the early stages of treatment when behaviour change was initiated (weekly in-session weighing, establishing regular eating, and ceasing binge-eating and compensatory behaviours). The present study found no evidence that alliance was related to treatment retention or outcomes, or that symptom severity or problematic interpersonal styles interacted with alliance to influence outcomes. Alliance was also unrelated to baseline emotional or interpersonal difficulties. The study provides no evidence that alliance has clinical utility for the prediction of treatment retention or outcome in CBT-E for BN, even for individuals with severe symptoms or problematic interpersonal styles. Early symptom change was the best predictor of outcome in CBT-E. Further research is needed to determine whether these results are generalizable to patients with anorexia nervosa.

摘要

本研究评估了增强型认知行为疗法(CBT-E)过程中治疗联盟的变化情况,共纳入了 112 名神经性贪食症(BN)或不典型 BN 患者。在治疗的三个时间点(开始、中期和结束时)对联盟进行了时间评估,并探讨了联盟与治疗保留和结果之间的关系。结果表明,患者与治疗师之间的联盟在 CBT-E 的所有阶段都很强,甚至在行为改变开始时(每周在诊室内称重、建立有规律的饮食、停止暴食和补偿行为)的早期阶段也有所改善。本研究没有发现证据表明联盟与治疗保留或结果有关,也没有证据表明症状严重程度或有问题的人际风格与联盟相互作用会影响结果。联盟与基线时的情绪或人际困难也没有关系。该研究没有证据表明,在 BN 的 CBT-E 中,联盟对治疗保留或结果具有临床实用性,即使是对症状严重或人际风格有问题的个体也是如此。早期症状变化是 CBT-E 结果的最佳预测因素。需要进一步的研究来确定这些结果是否可以推广到厌食症患者。

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