University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust, UK.
University of Sheffield, UK.
Psychol Psychother. 2021 Mar;94 Suppl 1:96-119. doi: 10.1111/papt.12278. Epub 2020 May 12.
A primary methodological weakness of the single-case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross-over design and so are deemed quasi-experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics.
The study employed an A /B /A /B with extended follow-up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6-week baseline period 'A ', treatment occurred in two phases (21 sessions 'B ' and 24 sessions 'B ') sandwiching a 12-week treatment withdrawal phase ('A ') and a 24-week structured follow-up phase. Seven idiographic daily measures were collected that created a N = 698 day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session.
There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant's self-to-self relationship, as their self-hate reduced and their sense-of-self increased. There was a broad pattern of deterioration during the second treatment phase (B ) and follow-up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self-to-other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase.
The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed.
Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow-up to capture any emerging relapse. Therapists need to discuss the patient's thoughts and feelings about termination regularly in a relationally informed manner.
采用认知分析疗法（CAT）治疗人格障碍的单病例实验设计（SCED）结果研究存在一个主要的方法学缺陷，即它们未能采用退出阶段或交叉设计，因此被认为是准实验。本研究旨在实施退出设计，以提高研究的内部有效性，使其成为真正的 SCED，并且还能够使患者探索放弃的动力。
该研究采用 A /B /A /B 延长随访 SCED，对一名符合边缘型人格障碍（BPD）诊断标准的女性患者进行 CAT 治疗。在 6 周的基线期（A）之后，治疗分为两个阶段（21 次 B 和 24 次 B），夹在 12 周的治疗退出期（A）和 24 周的结构化随访期。收集了 7 项个体每日测量数据，创建了 N = 698 天的时间线。在基线和研究每个阶段结束时收集了名义测量结果，并且在每次治疗后都完成了治疗会议影响量表。
治疗会议的任务焦点显著增加。从个体角度来看，CAT 是一种有效的治疗方法，可以改善参与者的自我与自我关系，因为他们的自我仇恨减少，自我感增强。在第二治疗阶段（B）和随访阶段，个体测量指标都出现了广泛的恶化模式，CAT 对 BPD 个体情绪或自我与他人的测量指标无效。从基线到第一治疗阶段结束，主要的 BPD 名义测量结果发生了可靠的变化。
该研究表明，CAT 干预部分有效，并且可以将良好的研究实践与临床创新相结合。讨论了设计的方法学优势和局限性以及结果的临床意义。
认知分析疗法在治疗对其他心理干预无反应的 BPD 病例中部分有效。治疗师需要完成冗长而结构化的随访，以捕捉任何新出现的复发。治疗师需要以关系为导向的方式定期讨论患者对终止的想法和感受。
