Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center.
Department of Clinical Psychology, VU University Amsterdam.
J Consult Clin Psychol. 2017 May;85(5):471-483. doi: 10.1037/ccp0000182. Epub 2017 Feb 2.
Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These "patient response patterns" (PRPs) indicate individuals' responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The "prognosis moderation hypothesis" states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups ("pliant-like") will have stronger process-outcome relationships than good ("easy-like") or poor ("challenging-like") groups.
N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. "Easy-like," "pliant-like" and "challenging-like" groups were created and the engagement-outcome relationship was assessed as a function of group.
Engagement-outcome correlations by PRP were: easy-like, r = -.27 (p < .05); pliant-like, r = -.36 (p < .01); and challenging-like, r = .05 (p = .70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12.
The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The "pliant-like" group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs. (PsycINFO Database Record
理解治疗方法的作用是心理治疗研究的目标，然而治疗过程和结果之间的关系强度并不一致。DeRubeis、Cohen 等人（2014 年）提出，过程-结果关系受到患者特征的调节。这些“患者反应模式”（PRP）表明个体对治疗的有效成分的反应性。在接受相同质量的治疗的情况下，一个人可能会比另一个人获得更多的收益，这取决于他们的 PRP。“预后调节假说”指出，PRP 可以通过治疗前的预后指标来定义。中等预后组（“顺从型”）与良好预后组（“轻松型”）或差预后组（“挑战型”）相比，其过程-结果关系更强。
N=190 名个体接受了无指导的计算机化 CBT。他们 58%为女性，年龄 44.7 岁。参与 cCBT 计划是过程变量。PRP 由预后回归模型的预测分数定义。结果是 3、6 和 12 个月时的 BDI 评分。创建了“轻松型”、“顺从型”和“挑战型”组，并评估了组间的参与-结果关系。
按 PRP 划分的参与-结果相关性为：轻松型，r=-.27（p<.05）；顺从型，r=-.36（p<.01）；挑战型，r=-.05（p=.70）。发现顺从型组是参与-结果关系的唯一调节因素。6 个月时的结果相似，但 12 个月时效果减弱。
参与-结果关系因预后而异，为预后调节假说提供了支持。“顺从型”组对治疗程序最为敏感。需要进一步研究来改进识别 PRP 的方法。
