Solomonov Nili, van-Doorn Katie Aafjes, Lipner Lauren M, Gorman Bernard S, Milrod Barbara, Rudden Marie G, Chambless Dianne L, Barber Jacques P
Department of Psychiatry, Weill Cornell Medical College.
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College.
J Contemp Psychother. 2019;49(4):255-264. doi: 10.1007/s10879-019-09434-7. Epub 2019 Jun 20.
To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' quality of object relations.
A subsample of 102 patients diagnosed with panic disorder from a larger randomized controlled trial received either Cognitive-Behavioral Therapy or Panic-Focused Psychodynamic Psychotherapy. We investigated whether baseline levels and change in both PSRF and BPD traits (as measured by the SCID-II) predicted pre-post change in quality of object relations (QOR), while controlling for pre-post treatment change in panic symptoms assessed by the Panic Disorder Severity Scale.
In both treatments, higher baseline levels of PSRF and lower levels of BPD traits, as well as pre-post decrease in BPD traits, predicted improvement in QOR when controlling for symptomatic change.
The findings suggest that reduction in comorbid BPD traits can facilitate improvement in patients' quality of object relations even in brief symptom-focused psychotherapies. Additionally, patients with higher baseline levels of symptom-focused reflective function and lower BPD traits are more likely to demonstrate interpersonal change over the course of psychotherapy for panic disorder. Finally, our study highlights the importance of examining therapeutic change beyond reduction in symptoms, particularly in domains of interpersonal functioning.
研究（a）惊恐特异性反思功能（PSRF，即患者反思其惊恐症状的能力）的基线水平以及治疗过程中该能力的改善情况；（b）基线边缘型人格障碍（BPD）特质以及治疗前后BPD特质的改善情况是否能预测患者客体关系质量的变化。
从一项更大规模的随机对照试验中选取102名被诊断为惊恐障碍的患者作为子样本，他们接受了认知行为疗法或聚焦惊恐的心理动力心理治疗。我们研究了PSRF和BPD特质的基线水平及变化（通过SCID-II测量）是否能预测客体关系质量（QOR）的治疗前后变化，同时控制由惊恐障碍严重程度量表评估的治疗前后惊恐症状的变化。
在两种治疗中，控制症状变化后，PSRF的较高基线水平、BPD特质的较低水平以及BPD特质的治疗前后降低，均能预测QOR的改善。
研究结果表明，即使在以症状为重点的简短心理治疗中，共病BPD特质的减少也能促进患者客体关系质量的改善。此外，在惊恐障碍的心理治疗过程中，具有较高基线水平的以症状为重点的反思功能和较低BPD特质的患者更有可能表现出人际变化。最后，我们的研究强调了在症状减轻之外检查治疗变化的重要性，特别是在人际功能领域。
