Sasso Katherine E, Strunk Daniel R, Braun Justin D, DeRubeis Robert J, Brotman Melissa A
Department of Psychology, The Ohio State University.
Department of Psychology, University of Pennsylvania.
J Consult Clin Psychol. 2015 Oct;83(5):976-84. doi: 10.1037/ccp0000045. Epub 2015 Jul 27.
Little is known about the influence of patients' pretreatment characteristics on the adherence-outcome relation in cognitive therapy (CT) for depression. In a sample of 57 depressed adults participating in CT, the authors examined interactions between pretreatment patient characteristics and therapist adherence in predicting session-to-session symptom change.
Using items from the Collaborative Study Psychotherapy Rating Scale, the authors assessed 3 facets of therapist adherence: cognitive methods, negotiating/structuring, and behavioral methods/homework. Two graduate students rated Sessions 1-4 for adherence. Symptoms were assessed prior to each session with the Beck Depression Inventory-II. Moderators were assessed as part of patients' intake evaluations.
After correcting for multiple comparisons, patient gender remained a significant moderator of the relationship between cognitive methods and next-session symptom change; cognitive methods more strongly predicted greater symptom improvement for women as compared to men. Pretreatment anxiety and number of prior depressive episodes were significant moderators of the relationship between behavioral methods/homework and next-session symptom change, with greater behavioral methods/homework predicting symptom improvement more strongly among patients high in pretreatment anxiety and among patients with relatively few prior depressive episodes.
This is the first study to provide evidence of how therapist adherence is differentially related to outcome among depressed patients with different characteristics. If replicated, these findings may inform clinical decisions regarding the use of specific facets of adherence in CT for depression with specific patients.
关于患者治疗前特征对抑郁症认知疗法（CT）中依从性与治疗效果关系的影响，人们了解甚少。在一个由57名参与CT治疗的成年抑郁症患者组成的样本中，作者研究了治疗前患者特征与治疗师依从性之间的相互作用，以预测逐次治疗期间症状的变化。
作者使用合作研究心理治疗评定量表中的项目，评估了治疗师依从性的三个方面：认知方法、协商/结构化以及行为方法/家庭作业。两名研究生对第1至4次治疗的依从性进行了评分。每次治疗前用贝克抑郁量表第二版评估症状。作为患者入院评估的一部分，对调节变量进行了评估。
在对多重比较进行校正后，患者性别仍然是认知方法与下一次治疗症状变化之间关系的显著调节变量；与男性相比，认知方法对女性症状改善的预测作用更强。治疗前焦虑和既往抑郁发作次数是行为方法/家庭作业与下一次治疗症状变化之间关系的显著调节变量，在治疗前焦虑程度高的患者以及既往抑郁发作次数相对较少的患者中，更多的行为方法/家庭作业对症状改善的预测作用更强。
这是第一项提供证据表明治疗师依从性如何与不同特征的抑郁症患者的治疗效果存在差异关联的研究。如果这些发现得到重复验证，可能会为针对特定患者在抑郁症CT治疗中使用依从性的特定方面提供临床决策依据。
