Zilcha-Mano Sigal, Roose Steven P, Barber Jacques P, Rutherford Bret R
Department of Psychology, University of Haifa, Haifa, Israel.
Psychother Psychosom. 2015;84(3):177-82. doi: 10.1159/000379756. Epub 2015 Mar 28.
Previous studies have shown that in psychotherapy alliance is a predictor of symptomatic change, even while accounting for the temporal precedence between alliance and symptoms. However, the extent to which alliance predicts outcomes in psychopharmacology is yet to be fully investigated considering the fact that alliance can be the result, rather than the cause, of symptomatic change. The current prospective study examined whether the alliance predicts outcomes in psychopharmacology, while controlling for previous symptomatic change throughout the course of treatment.
Data from a psychopharmacological randomized controlled trial for the treatment of adult major depression (n = 42), including the patients' rating of the alliance with the physicians, were analyzed. Multilevel models controlling for autoregressive lag of the dependent variable were used in all analyses to examine the effect of alliance on outcome.
The effect of alliance on outcome, while controlling for prior symptomatic levels, was significant and restricted to the middle phase of treatment (week 4, p = 0.005), when most of the reductions in symptoms were observed. Exploratory analyses of the differences between placebo and medication conditions suggest that the differences between the patients in their average alliance levels predicted a greater reduction in symptoms in the placebo compared to the medication conditions (p = 0.008). The main limitation is the small cohort size.
The findings suggest an effect of alliance on outcome in psychopharmacology, which is not merely the result of previous symptomatic levels. This effect may be more robust in conditions that do not include active treatment (placebo), possibly serving as a compensatory effect.
以往研究表明，在心理治疗中，即便考虑到治疗联盟与症状之间的时间先后顺序，治疗联盟仍是症状改善的一个预测指标。然而，鉴于治疗联盟可能是症状改善的结果而非原因，治疗联盟在心理药理学中对治疗结果的预测程度尚未得到充分研究。当前的前瞻性研究在控制治疗过程中既往症状变化的同时，考察了治疗联盟是否能预测心理药理学的治疗结果。
对一项治疗成人重度抑郁症的心理药理学随机对照试验（n = 42）的数据进行分析，其中包括患者对与医生治疗联盟的评分。在所有分析中均使用控制因变量自回归滞后的多层次模型，以考察治疗联盟对治疗结果的影响。
在控制既往症状水平的情况下，治疗联盟对治疗结果的影响显著，且仅限于治疗中期（第4周，p = 0.005），此时观察到症状有大部分减轻。对安慰剂组和药物治疗组差异的探索性分析表明，与药物治疗组相比，患者平均治疗联盟水平的差异预示着安慰剂组症状减轻得更多（p = 0.008）。主要局限性在于样本量较小。
研究结果表明治疗联盟对心理药理学的治疗结果有影响，这不仅仅是既往症状水平的结果。在不包括积极治疗（安慰剂）的情况下，这种影响可能更强，可能起到一种补偿作用。
