Department of Psychiatry and Psychotherapy.
Faculty of Psychology/ Educational Science and Sport Science, University of Regensburg.
J Consult Clin Psychol. 2018 Jul;86(7):584-592. doi: 10.1037/ccp0000302.
Alliance, Mastery/Self-Efficacy, Problem Actualization, and Problem Clarification exemplify common or nonspecific factors of change in psychotherapy (Grawe, 1997). In this study, we tested the hypothesis that other change factors mediate the alliance-outcome link on a within-person level over the treatment course.
Our sample consisted of 193 patients with major depression undergoing intensive inpatient cognitive-behavioral-based therapy. Each week, we assessed depressive symptoms (using the Beck Depression Inventory-II) and change factors during individual therapy. Multilevel mediation models were used to test our hypothesis.
As expected, within-person change in Alliance (differentiated into Emotional Bond and Contentment with the Therapist) as well as Mastery/Self-Efficacy and Problem Clarification predicted symptom change over the course of therapy. Moreover, the relation between Contentment with the Therapist and subsequent change in depression was mediated by increased Mastery/Self-Efficacy on a within-person level.
Our data suggest that within-person change of alliance and other general change factors precede symptom change in depressive patients, and that the link between alliance and outcome may be partially mediated by enhanced Mastery/Self-Efficacy. Future studies should further elucidate the mechanisms responsible for the alliance-outcome link. (PsycINFO Database Record
联盟、掌握/自我效能、问题具体化和问题澄清是心理治疗中常见的或非特定的变化因素（Grawe，1997）。在这项研究中，我们测试了这样一个假设，即在治疗过程中，其他变化因素在个体水平上对联盟结果的联系起中介作用。
我们的样本由 193 名患有重度抑郁症的患者组成，他们接受了强化住院认知行为基础治疗。每周，我们在个体治疗中评估抑郁症状（使用贝克抑郁量表-第二版）和变化因素。使用多层次中介模型来检验我们的假设。
正如预期的那样，在治疗过程中，个体内的联盟变化（分为情感纽带和对治疗师的满意）以及掌握/自我效能和问题澄清预测了症状的变化。此外，对治疗师的满意与随后的抑郁变化之间的关系在个体内通过增强掌握/自我效能来介导。
我们的数据表明，在抑郁患者中，个体内的联盟变化和其他一般变化因素先于症状变化，而联盟和结果之间的联系可能部分通过增强掌握/自我效能来介导。未来的研究应该进一步阐明负责联盟结果联系的机制。
