Anderson Timothy, McClintock Andrew S, McCarrick Shannon S, Heckman Timothy G, Heckman Bernadette D, Markowitz John C, Sutton Mark
Ohio University.
University of Georgia.
J Clin Psychol. 2018 Mar;74(3):286-303. doi: 10.1002/jclp.22502. Epub 2017 Jun 6.
Interpersonal psychotherapy (IPT) has demonstrated efficacy for the treatment of depression, yet little is known about its therapeutic mechanisms. As a specific treatment, IPT has been shown to directly reduce depressive symptoms, although it is unclear whether these reductions occur via interpersonal changes. Within IPT, the potential role of the working alliance, a common factor, as a predictor of depression and interpersonal changes is also unclear.
Participants were 147 depressed persons living with HIV in rural communities of 28 U.S. states enrolled in a randomized clinical trial. Seventy-five patients received up to 9 sessions of telephone-administered IPT (tele-IPT) plus standard care and 72 patients received standard care only. Two models were tested; one included treatment condition (tele-IPT vs. control) and another included the working alliance as independent variables.
The first model found an indirect effect whereby tele-IPT reduced depression via decreased social avoidance. There was a direct effect between tele-IPT and reduced depression. In the second model, the working alliance influenced depressive symptom relief via reductions in social avoidance. Both goal and task working alliance subscales were indirectly associated with reductions in depressive symptoms, also through reductions in social avoidance. There were no direct effects involving the working alliance. Tele-IPT's influence on depressive symptom reduction was primarily through a direct effect, whereas the influence of working alliance depression was almost entirely via an indirect effect through interpersonal problems.
Study findings have implications for IPT when intervening with depressed rural people living with HIV/AIDS over the telephone.
人际心理治疗（IPT）已被证明对抑郁症治疗有效，但其治疗机制却鲜为人知。作为一种特定治疗方法，IPT已显示可直接减轻抑郁症状，不过尚不清楚这些症状减轻是否通过人际关系变化实现。在IPT中，作为一个共同因素的工作联盟作为抑郁症和人际关系变化预测指标的潜在作用也不明确。
参与者为美国28个州农村社区的147名感染艾滋病毒的抑郁症患者，他们参与了一项随机临床试验。75名患者接受了最多9次电话人际心理治疗（电话IPT）加标准护理，72名患者仅接受标准护理。测试了两个模型；一个模型纳入治疗条件（电话IPT与对照组），另一个模型纳入工作联盟作为自变量。
第一个模型发现了一种间接效应，即电话IPT通过减少社交回避来减轻抑郁。电话IPT与减轻抑郁之间存在直接效应。在第二个模型中，工作联盟通过减少社交回避来影响抑郁症状缓解。目标和任务工作联盟分量表也都通过减少社交回避与抑郁症状减轻间接相关。不存在涉及工作联盟的直接效应。电话IPT对减轻抑郁症状的影响主要通过直接效应，而工作联盟对抑郁的影响几乎完全通过人际关系问题产生间接效应。
研究结果对通过电话干预感染艾滋病毒/艾滋病的农村抑郁症患者的人际心理治疗具有启示意义。
