Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Hospital Wolfenbüttel gGmbH, Wolfenbüttel, Germany.
BMC Psychiatry. 2017 Dec 29;17(1):417. doi: 10.1186/s12888-017-1579-5.
Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care.
The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only.
Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness.
Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change.
clinicaltrials.gov Identifier: NCT01357694.
改变的意愿是心理治疗研究的关键结构，也是动机干预的主要目标。我们的主要目标是检验术前改变的准备程度是否调节了 Bridging Intervention in Anesthesiology（BRIA）的治疗效果，BRIA 是一种针对手术患者的创新心理治疗方法。该递进式护理方案旨在激励和支持患有精神障碍的手术患者接受社会心理保健。
BRIA 的主要步骤是两个不同强度的动机干预。该方案的第一步是包括心理困扰筛查在内的术前计算机辅助社会心理自评，以及自动生成的计算机书面简要建议（BWA）。在第二步中，患者参加结合动机访谈和认知行为疗法的术后心理治疗（BRIA 心理治疗）。我们对我们研究小组最近发表的一项随机对照试验的数据进行了基于回归的调节分析。该样本包括 220 名患有各种合并精神障碍的手术患者，根据 ICD-10 分类，最常见的疾病是情绪、焦虑、物质使用和适应障碍。患者的平均年龄为 43.31 岁，其中 60.90%为女性。在调整了术前心理困扰的回归模型中，我们调查了改变的准备程度是否调节了 BRIA 心理治疗与（1）BRIA 心理治疗和（2）无心理治疗/仅 BWA 之间的治疗效果差异。
多元回归分析表明，改变的准备程度调节了主要结果的治疗效果，即“在 6 个月时参加社会心理保健选择”（p=0.03）和“在 6 个月时接触社会心理保健选择”（p=0.048），但对次要结果“从基线评估到 6 个月时的一般心理困扰变化”（p=0.329）没有影响。使用 Johnson-Neyman 技术探测调节效应显示，BRIA 心理治疗在低到中度准备的患者中优于 BWA，但在高准备的患者中则不然。
改变的准备程度可能是社会心理治疗效果的调节因素。动机访谈和认知行为疗法的组合可能对患有多种精神障碍和改变意愿较低的患者有效。
clinicaltrials.gov 标识符：NCT01357694。
