Renner Fritz, DeRubeis Robert, Arntz Arnoud, Peeters Frenk, Lobbestael Jill, Huibers Marcus J H
MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States.
J Behav Ther Exp Psychiatry. 2018 Mar;58:97-105. doi: 10.1016/j.jbtep.2017.10.002. Epub 2017 Oct 6.
The underlying mechanisms of symptom change in schema therapy (ST) for chronic major depressive disorder (cMDD) have not been studied. The aim of this study was to explore the impact of two potentially important mechanisms of symptom change, maladaptive schemas (proxied by negative idiosyncratic core-beliefs) and the therapeutic alliance.
We drew data from a single-case series of ST for cMDD. Patients with cMDD (N = 20) received on average 78 repeated weekly assessments over a course of up to 65 individual sessions of ST. Focusing on repeated assessments within-individuals, we used mixed regression to test whether change in core-beliefs and therapeutic alliance preceded, followed, or occurred concurrently with change in depressive symptoms.
Changes in core-beliefs did not precede but were concurrently related to changes in symptoms. Repeated goal and task agreement ratings (specific aspects of alliance) of the same session, completed on separate days, were at least in part associated with concurrent changes in symptoms.
By design this study had a small sample-size and no control group.
Contrary to what would be expected based on theory, our findings suggest that change in core-beliefs does not precede change in symptoms. Instead, change in these variables occurs concurrently. Moreover, alliance ratings seem to be at least in part colored by changes in current mood state.
针对慢性重度抑郁症（cMDD）的图式疗法（ST）中症状变化的潜在机制尚未得到研究。本研究旨在探讨症状变化的两个潜在重要机制——适应不良图式（以消极特质核心信念为代表）和治疗联盟的影响。
我们从一系列针对cMDD的ST单病例研究中提取数据。20名cMDD患者在长达65次个体ST疗程中平均接受了78次每周重复评估。聚焦个体内部的重复评估，我们使用混合回归来检验核心信念和治疗联盟的变化是先于、后于还是与抑郁症状的变化同时发生。
核心信念的变化并非先于症状变化，而是与症状变化同时相关。在不同日期完成的同一次治疗中重复的目标和任务达成评分（联盟的特定方面）至少部分与症状的同时变化相关。
本研究设计上样本量小且无对照组。
与基于理论的预期相反，我们的研究结果表明核心信念的变化并非先于症状变化。相反，这些变量的变化同时发生。此外，联盟评分似乎至少部分受到当前情绪状态变化的影响。
