Department of Psychology.
Modum Bad Research Institute.
J Couns Psychol. 2020 Jan;67(1):51-65. doi: 10.1037/cou0000375. Epub 2019 Aug 1.
To date, eating disorder (ED) treatments are lacking for ED patients with psychiatric sequelae of childhood trauma, and successful outcomes are scarce. Therefore, the aim of this study was to explore therapeutic change processes from a patient perspective in relation to good versus poor long-term ED outcome at 1-year follow-up. Outcome categories were based on clinician assessment of ED behavior and diagnoses, body mass index, and Eating Disorder Examination Questionnaire scores. Eleven White, cisgendered female ED patients with childhood trauma were interviewed after a 3-month inpatient treatment: data was analyzed with elements from grounded theory and interpretative phenomenological analysis. The qualitative analysis rendered change-related descriptions (9 subcategories) and obstacles to change (6 subcategories), and 3 process-related domains differentiated good from poor long-term outcome: trauma exposure (4 subcategories), patient agency (6 subcategories), and patient-therapist dynamics (3 subcategories). First, sensory and emotional trauma exposure in good outcome informants was contrasted with avoiding or not addressing trauma and body in poor outcome informants. Second, promotion of patient agency while receiving support in the good outcome group was contrasted to an orientation toward others' needs, distrust in own abilities, and difficulties showing vulnerability in the poor outcome group. Third, poor outcome informants described either a distanced or immersed/idealizing relationship to their therapist, as opposed to more balanced between self-assertion and vulnerability in good outcome informants. Our findings raise new hypotheses that trauma work, fostering patient agency, and focusing on relational dynamics in patient-therapist dyad may be important in producing enduring ED outcomes for these patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
迄今为止，对于有儿童期创伤后精神后遗症的饮食失调症（ED）患者，缺乏 ED 治疗方法，而且治疗效果也很少成功。因此，本研究旨在从患者的角度探讨治疗变化过程，以了解在 1 年随访时良好和不良长期 ED 结局的关系。结局类别基于临床医生对 ED 行为和诊断、体重指数和饮食失调检查问卷评分的评估。11 名患有儿童期创伤的白人顺性别女性 ED 患者在接受 3 个月住院治疗后接受了访谈：使用扎根理论和解释性现象学分析的元素对数据进行了分析。定性分析得出了与变化相关的描述（9 个子类别）和改变的障碍（6 个子类别），并确定了 3 个与过程相关的领域，将良好和不良的长期结局区分开来：创伤暴露（4 个子类别）、患者能动性（6 个子类别）和医患动态（3 个子类别）。首先，良好结局的受访者对感官和情感创伤暴露的描述与不良结局的受访者避免或不处理创伤和身体形成对比。其次，在良好结局的受访者中，促进患者能动性的同时获得支持，与在不良结局的受访者中倾向于他人的需求、不信任自己的能力以及难以表现出脆弱性形成对比。第三，不良结局的受访者描述了与治疗师之间疏远或投入/理想化的关系，而良好结局的受访者则在自我主张和脆弱性之间更加平衡。我们的研究结果提出了新的假设，即创伤工作、培养患者能动性以及关注医患关系中的动态，可能对这些患者产生持久的 ED 结局至关重要。（APA，所有权利保留）。
