de Roten Yves, Djillali Slimane, Crettaz von Roten Fabienne, Despland Jean-Nicolas, Ambresin Gilles
Institute of Psychotherapy, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
Faculty of the Social and Political Sciences, University of Lausanne, Lausanne, Switzerland.
Front Psychol. 2021 Mar 18;12:633939. doi: 10.3389/fpsyg.2021.633939. eCollection 2021.
The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery-Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient's defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.
该研究调查了在住院环境中，针对复发性和慢性抑郁症的简短心理动力心理治疗中，防御功能和防御机制在多大程度上能够预测具有临床意义的症状改善情况。治疗反应被定义为蒙哥马利-阿斯伯格抑郁评定量表（MADRS）上的症状严重程度较基线评分降低46%或更多。研究纳入了一项随机对照试验中的41名患者的子样本（19名反应者和22名无反应者）。对于每个病例，转录了简短住院心理动力心理治疗的两节课（第二节和倒数第二节，这是一个在洛桑开发的标准化的12节治疗方案），然后使用防御机制评定量表（DMRS）和精神病防御机制评定量表（P-DMRS，为研究精神病性防御而开发的一个额外量表）进行编码。结果显示，防御功能以及成熟和不成熟防御在心理治疗过程中发生了变化，并能预测治疗反应。在整个治疗过程中观察到的患者防御情况也能预测12个月随访时的治疗反应。加入精神病性防御能更好地预测治疗反应。总体而言，这些结果与先前的研究一致，并进一步验证了防御功能作为治疗结果预测指标和心理治疗中变化机制的作用。
