University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
University of California, Los Angeles, Department of Psychiatry and Biobehavioral Science, 760 Westwood Plaza, Los Angeles, CA 90095, USA.
Behav Res Ther. 2017 Apr;91:13-23. doi: 10.1016/j.brat.2017.01.001. Epub 2017 Jan 4.
No prior studies have examined moderators of dropout between distinct treatments for anxiety disorders. This study applied a novel statistical approach for examining moderators of dropout from traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).
We combined data from two randomized controlled trials (N = 208) comparing CBT and ACT for patients with DSM-IV anxiety disorders. Adapting Kraemer's method for constructing and evaluating composite moderators (2013), 26 variables were examined for individual effect sizes. Forward-stepwise regression combined with k-fold cross validation was used to identify a model to predict treatment dropout.
Four baseline variables comprised the final composite moderator: self-reported degree of control over internal anxiety, current psychiatric medication use, religiosity, and endurance in a voluntary hyperventilation stressor. This composite moderator predicted differential dropout from ACT vs. CBT with a medium effect size (r = 0.28), and had a significantly larger effect size than any individual moderator.
Findings reveal that specific patient profiles predict differential dropout from ACT vs. CBT for anxiety disorders. In the first investigation of a composite moderator with a dichotomous outcome, findings also support the superiority of composite over individual moderators.
先前的研究尚未检验焦虑障碍不同治疗方法之间辍学的调节因素。本研究应用了一种新的统计方法来检验传统认知行为疗法（CBT）和接受与承诺疗法（ACT）辍学的调节因素。
我们结合了两项比较 DSM-IV 焦虑障碍患者 CBT 和 ACT 的随机对照试验的数据（N=208）。根据 Kraemer 构建和评估综合调节因素的方法（2013），对 26 个变量进行了个体效应大小的检验。采用逐步向前回归结合 k 折交叉验证来确定一个预测治疗辍学的模型。
四个基线变量构成了最终的综合调节因素：自我报告的对内部焦虑的控制程度、当前精神药物的使用、宗教信仰和自愿性过度通气应激源的耐力。这个综合调节因素预测了 ACT 与 CBT 之间辍学的差异，具有中等效应大小（r=0.28），并且比任何单个调节因素的效应都大。
研究结果表明，特定的患者特征预测了焦虑障碍中 ACT 与 CBT 之间辍学的差异。在对二项结果进行综合调节因素的首次研究中，研究结果还支持了综合调节因素优于个体调节因素。
