Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, Leipzig, Germany.
Eur Eat Disord Rev. 2019 Mar;27(2):182-194. doi: 10.1002/erv.2650. Epub 2018 Oct 18.
To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.
为了评估针对青少年暴食症（BED）的心理治疗方法，需要有关于治疗过程因素的可靠信息。本研究考察了认知行为疗法（CBT）中治疗师的依从性和治疗联盟及其与青少年 BED 的关联。在一项随机对照疗效试验中，根据 64 名 BED 青少年的 247 次音频 CBT 会话，客观确定了依从性和联盟。使用多层次模型检查了治疗模块、患者和治疗师对依从性和联盟的可变性的影响。尽管依从性和联盟都很好，不受治疗模块和治疗师的影响，但两个概念在患者之间都存在显著的可变性。依从性与患者的治疗期望呈负相关。联盟与失控进食发作次数呈负相关，与依从性呈正相关。对青少年 BED 的 CBT 具有良好的依从性支持了其内部有效性。过程因素与患者特征之间的关联要求在 CBT 中进行充分的监督。
