Michaelis Rosa, Schiepek Günter, Heinen Gerd Maria, Edelhäuser Friedrich, Viol Kathrin
Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Faculty of Psychology and Educational Sciences, Ludwig-Maximilians-University Munich, Germany; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.
Epilepsy Behav. 2021 Sep 21;124:108313. doi: 10.1016/j.yebeh.2021.108313.
There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes.
This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models.
Twenty patients [15 women/5 men, median age 48 years (range: 23-73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6-22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma.
The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.
将心理治疗有效整合到全面的癫痫护理中，以优化癫痫患者的治疗效果和心理社会功能，这在科学和临床领域引起了极大的关注。阶梯式护理是一种很有前景的方法，可在学术和常规门诊环境中提供个性化的心理治疗护理。它旨在为患者提供最适当的治疗时长、疗程数量和治疗方法，同时系统地监测他们的治疗过程。
这是一项在自然环境中针对癫痫进行的以过程为导向的个性化心理治疗护理的非对照可行性研究。本研究的目的是通过将可靠变化指数（RCI）的概念应用于干预开始时的基线和六个月后的结果，评估参与者健康相关生活质量（QOLIE - 31）和精神共病（BDI - II，BSI）的个体变化。此外，我们通过线性回归模型评估了结果分数、参加疗程数量和童年创伤史之间的关系。
招募了20名患者[15名女性/5名男性，中位年龄48岁（范围：23 - 73岁）]。预定疗程的中位数为11次（范围：6 - 22次）；没有患者退出。心理治疗后，生活质量（QOLIE - 31）、总体痛苦（BSI）和抑郁（BDI - II）评分显著改善（p值：QOLIE - 31：0.03；BSI：0.01；BDI - II：0.01）。QOLIE - 31的情感幸福感子量表（47%，p值：0.02）、BSI的总体严重程度指数（83%）和抑郁严重程度（BDI - II）（60%）改善最为显著。线性回归模型未显示中期变化、参加治疗疗程数量和童年创伤史之间存在任何显著关联。
结果表明，以过程为导向的个性化心理治疗在癫痫患者中具有低脱落率，并能改善生活质量和减轻精神症状。我们的研究结果表明，对心理治疗的反应性不依赖于参加治疗疗程的数量。有童年创伤的参与者不需要更多的治疗疗程就能取得改善。需要更多的研究来理解和解决心理治疗反应性的机制和先兆因素。
