Universidad de Buenos Aires (CONICET), Buenos Aires, Argentina & Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
J Behav Ther Exp Psychiatry. 2020 Dec;69:101576. doi: 10.1016/j.jbtep.2020.101576. Epub 2020 May 4.
This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome.
One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects.
We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up.
The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment.
Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression.
本文探讨了认知心理疗法治疗抑郁症后内隐和外显消极自我联想（NSA）之间的差异，以此作为长期预后的预测指标。
120 名患者在限时门诊抑郁症心理治疗结束时完成了与抑郁属性相关的内隐联想测试（IAT）和具有相同项目内容的自我报告问卷。在治疗后以及 3、6 和 12 个月随访时，患者完成了 BDI-II。我们使用不同的策略对内隐和外显 NSA 差异进行了操作化，并使用三级层次线性模型分析了这些差异的影响。
我们发现内隐和外显 NSA 差异与差异方向对长期预后的交互作用显著。在外显 NSA 大于内隐 NSA 的患者（自尊心受损模式）中，在随访结束时 BDI 评分和随访期间的变化率方面，绝对差异越大，长期预后越差。同样，使用替代方法，我们发现自尊心受损差异与随访结束时估计的 BDI-II 评分较差相关。
仅纳入完成治疗的患者样本限制了结果的普遍性。此外，随访期仅涵盖了治疗结束后的前 12 个月。
我们的结果支持这样一种观点，即内隐和外显消极自我联想之间的差异可能是抑郁症心理治疗后恶化的一个风险因素。
