Tomba Elena, Tecuta Lucia, Schumann Romana, Ballardini Donatella
Department of Psychology, University of Bologna, Bologna, Italy.
Department of Psychology, University of Bologna, Bologna, Italy.
Compr Psychiatry. 2017 Apr;74:61-69. doi: 10.1016/j.comppsych.2017.01.001. Epub 2017 Jan 7.
Psychological well-being changes following cognitive-behavioral therapy-based treatment were investigated in outpatients with eating disorders (ED). While it is known that CBT reduces symptomatology in EDs, less is known about how changes in positive functioning may ensue. One-hundred and eighty five ED outpatients were analyzed for pre-treatment and post-treatment changes in psychological well-being (PWB) by last observation carried forward - Wilcoxon signed rank tests. Significant gains in all PWB dimensions were found, with moderate effect size correlations in environmental mastery (r=-.418), personal growth (r=-.351) and self-acceptance (r=-.341). A subsample of patients in remission (n=51) was selected and compared to healthy controls in PWB post-treatment scores through Mann-Whitney U tests. Remitted patients showed significantly lower psychological well-being in two dimensions compared to controls: PWB-positive relations (r=-.360) and PWB-self-acceptance (r=-.288). However, more than 50% of ED outpatients in remission had PWB scores that fell below the 50th percentile of healthy controls in all psychological well-being dimensions, despite significant treatment response. Several mechanisms of psychological well-being change following CBT-based treatment are discussed. The assessment of treatment outcome in EDs may benefit from considering changes in positive functioning such as psychological well-being, in addition to the standard measurement of BMI, symptomatology and behavioral parameters. CBT-based treatment outcomes may be strengthened by promoting the development of optimal domains particularly in the interpersonal realm, such as building of quality and warm relationships and focusing on enhancing self-acceptance.
对饮食失调（ED）门诊患者接受基于认知行为疗法的治疗后的心理健康变化进行了调查。虽然已知认知行为疗法（CBT）可减轻饮食失调的症状，但对于积极功能如何随之改变却知之甚少。采用末次观察结转法——Wilcoxon符号秩检验，对185名饮食失调门诊患者治疗前和治疗后的心理健康（PWB）变化进行了分析。发现所有心理健康维度均有显著改善，在环境掌控（r = -0.418）、个人成长（r = -0.351）和自我接纳（r = -0.341）方面有中等效应大小的相关性。选取了一组缓解期患者（n = 51），通过Mann-Whitney U检验将其治疗后的心理健康得分与健康对照组进行比较。与对照组相比，缓解期患者在两个维度上的心理健康水平显著较低：心理健康——积极关系（r = -0.360）和心理健康——自我接纳（r = -0.288）。然而，尽管治疗反应显著，但缓解期超过50%的饮食失调门诊患者在所有心理健康维度上的得分均低于健康对照组的第50百分位数。讨论了基于认知行为疗法的治疗后心理健康变化的几种机制除了对体重指数、症状和行为参数进行标准测量外，饮食失调治疗结果的评估可能受益于考虑心理健康等积极功能的变化。通过促进最佳领域的发展，特别是在人际领域，如建立高质量和温暖的关系以及专注于增强自我接纳，基于认知行为疗法的治疗结果可能会得到加强。
