Marcotte-Beaumier Gabrielle, Bouchard Stéphane, Gosselin Patrick, Langlois Frédéric, Belleville Geneviève, Marchand André, Dugas Michel J
Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, QC, Canada.
Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada.
JMIR Ment Health. 2021 Mar 15;8(3):e24541. doi: 10.2196/24541.
Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance.
As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome.
A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up.
The results revealed that the therapeutic bond did not predict treatment outcome (r=-0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=-0.42; P=.004 and r=-0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=-0.03; r=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome.
These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change.
International Standard Randomized Controlled Trial Number (ISRCTN): 12662027; http://www.isrctn.com/ISRCTN12662027.
以往的荟萃分析表明，工作联盟与总体治疗效果之间存在显著关系。一些研究探讨了远程心理治疗中工作联盟与治疗效果之间的关系，但据我们所知，尚无研究考察工作联盟各个组成部分的中介作用。
作为一项针对广泛性焦虑障碍（GAD）的认知行为疗法（CBT）视频会议（VC）临床试验的一部分，本研究旨在考察不确定性不耐受在工作联盟各组成部分与治疗效果之间关系中的中介作用。
46名患有原发性广泛性焦虑障碍的成年人接受了15次通过视频会议进行的针对广泛性焦虑障碍的认知行为疗法治疗。参与者在第五次治疗 session 后立即完成工作联盟测量。从治疗前到治疗后评估不确定性不耐受（一个关键心理过程）的变化程度。通过从治疗前到6个月随访期间广泛性焦虑障碍症状的变化来评估治疗效果。
结果显示，治疗关系并不能预测治疗效果（r = -0.23；P = 0.12）。然而，在治疗目标和任务上的一致性确实能预测治疗效果（分别为r = -0.42；P = 0.004和r = -0.37；P = 0.01）。此外，治疗任务上的共识与治疗效果之间的关系完全由不确定性不耐受的变化所中介（非标准化β = -0.03；r = 0.12），而相对于治疗目标的共识对治疗效果有直接影响。
这些结果有助于更好地理解工作联盟各组成部分在远程心理治疗中作为关键认知过程变化的促进因素的不同作用，从而带来治疗性改变。
国际标准随机对照试验编号（ISRCTN）：12662027；http://www.isrctn.com/ISRCTN12662027 。
