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初步研究心理治疗师的忠诚度在 RCT 中对认知加工疗法治疗与军事性创伤相关 PTSD 疗效的作用。

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD.

机构信息

a Research Service , Veterans Affairs North Texas Health Care System , 4500 S. Lancaster Rd. Research Service (151), Dallas , TX 75216 , USA.

b Department of Psychiatry , University of Texas Southwestern Medical Center , 5323 Harry Hines Blvd, Dallas , TX 75390 , USA.

出版信息

Cogn Behav Ther. 2018 Jan;47(1):76-89. doi: 10.1080/16506073.2017.1357750. Epub 2017 Aug 10.

Abstract

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists' fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. "below average") treatment fidelity scores compared to the other two therapists who had "good" treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with "good" treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with "below average" treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.

摘要

认知加工疗法(CPT)是一种针对许多与军事相关的创伤后应激障碍(PTSD)患者的有效循证治疗方法,但并非所有退伍军人都能从中受益。为了解释治疗效果的差异,研究人员已经调查了与患者和研究设计相关的因素;然而,治疗师因素(例如治疗的忠实程度)受到的关注较少。本研究初步考察了在一项针对军事性创伤相关 PTSD 的随机临床试验(RCT)中,CPT 治疗师忠实程度对临床结果的影响。对 72 名参与者在基线、治疗后 1 周、2 个月、4 个月和 6 个月时评估 PTSD 症状、与创伤相关的消极认知(NC)和抑郁症状。在 4 名 CPT 治疗师中,有 2 名治疗师的治疗忠实程度明显较差(即“低于平均水平”),而另外 2 名治疗师的治疗忠实程度较好。为了研究治疗师对结果的可能影响,采用层级线性建模,将治疗师忠实程度作为二级预测因素。与接受“低于平均水平”治疗忠实程度的治疗师治疗的患者相比,接受“良好”治疗忠实程度的治疗师治疗的患者 PTSD 症状、NC 和抑郁症状显著减轻。我们的初步发现强调了在心理治疗 RCT 中监测、维持和报告忠实程度的重要性。

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