From the Department of General Internal Medicine and Psychosomatics and the Institute of Medical Psychology, Heidelberg University, Heidelberg, Germany.
Am J Psychiatry. 2018 Oct 1;175(10):961-969. doi: 10.1176/appi.ajp.2018.17080847. Epub 2018 Aug 2.
An increased understanding of repetitive dysfunctional patterns and their relationship to an individual's life history is regarded as a key mechanism of change in insight-oriented therapies. At the same time, empirical research on the insight-outcome relationship is rare, and its generalizability is restricted by the use of a wide range of definitions and methods among studies. The authors conducted a meta-analysis to systematically examine the association between patient insight and psychotherapy outcome across a range of treatment modalities.
Insight was defined as patients' understanding of associations between past and present experiences, typical relationship patterns, and the relation between interpersonal challenges, emotional experience, and psychological symptoms. From 13,849 initially identified abstracts, the authors extracted 23 independent effect sizes. A random-effects meta-analysis was performed to assess the magnitude of the insight-outcome relationship. Risk of publication bias was assessed with funnel plot inspections, Egger's regression test, and Duval and Tweedie's trim-and-fill procedure as sensitivity analyses.
A significant, moderate correlation (r=0.31) was observed between insight and treatment outcome. Sensitivity analyses demonstrated the robustness of the results.
The findings support the importance of insight for psychotherapy outcome. Insight may be a relevant mechanism of change across different treatment modalities.
对重复出现的功能失调模式及其与个体生活史之间关系的深入理解，被视为以洞察为导向的治疗中发生变化的关键机制。与此同时，关于洞察与结果之间关系的实证研究却很少，而且由于研究中广泛使用了多种定义和方法，其普遍性受到限制。作者进行了一项荟萃分析，以系统地考察了一系列治疗方式中患者洞察与心理治疗结果之间的关联。
洞察被定义为患者对过去和现在经历、典型关系模式以及人际挑战、情绪体验和心理症状之间关系的理解。从最初确定的 13849 篇摘要中，作者提取了 23 个独立的效应量。采用随机效应荟萃分析来评估洞察与结果之间关系的大小。通过漏斗图检查、Egger 回归检验以及 Duval 和 Tweedie 的修剪和填充程序来评估发表偏倚的风险，并将其作为敏感性分析。
洞察与治疗结果之间存在显著的中度相关性（r=0.31）。敏感性分析表明结果稳健。
这些发现支持洞察对心理治疗结果的重要性。洞察可能是不同治疗方式中变化的一个相关机制。
