VA Puget Sound Health Care System.
Department of Mathematics.
J Consult Clin Psychol. 2022 Mar;90(3):272-281. doi: 10.1037/ccp0000714. Epub 2022 Jan 27.
Although Dialectical Behavior Therapy (DBT) is a well-established evidence-based psychotherapy, little is known about the role of therapist adherence in promoting positive outcomes. This study evaluated the temporal relationships between therapist adherence to DBT and patient outcomes, as well as potential moderators of these relationships.
Data were from six clinical trials conducted in research and community settings with a variety of patient populations. In these trials, trained observers rated 83 therapists for adherence during 1,262 DBT individual therapy sessions with 288 patients. Patient outcomes included suicide attempts, nonsuicidal self-injury (NSSI), treatment dropout, psychiatric hospitalizations, and global functioning. Longitudinal mixed-effects models evaluated the time-ordered, bidirectional relationships between adherence and outcomes.
Higher therapist adherence significantly predicted fewer subsequent suicide attempts ( = .002, η = 0.32) and a lower risk of dropout ( = .002, η = 0.33), and the latter relationship was strongest among patients with comorbid opioid dependence. Higher therapist adherence predicted fewer subsequent hospitalizations among community therapists ( = .001, η = 0.35) and patients that were not exclusively suicidal/self-injuring ( < .001, η = 0.41). Conversely, more frequent NSSI ( = .03, η = 0.22) and worse global functioning ( = .01, η = 0.26) predicted higher subsequent therapist adherence, and the latter relationship was moderated by patient population.
Therapist adherence improves several key patient outcomes and retention, highlighting the importance of delivering DBT with adherence to the manual. Therapists may find it easier to deliver DBT adherently to more severely impaired patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
虽然辩证行为疗法（DBT）是一种经过充分验证的循证心理疗法，但对于治疗师的依从性在促进积极结果方面的作用知之甚少。本研究评估了治疗师对 DBT 的依从性与患者结果之间的时间关系，以及这些关系的潜在调节因素。
数据来自在研究和社区环境中进行的六项临床试验，涉及各种患者群体。在这些试验中，经过培训的观察员在 288 名患者的 1262 次 DBT 个体治疗中对 83 名治疗师进行了依从性评估。患者的结果包括自杀企图、非自杀性自伤（NSSI）、治疗脱落、精神病住院和整体功能。纵向混合效应模型评估了依从性和结果之间的时间顺序、双向关系。
更高的治疗师依从性显著预测了随后自杀企图次数减少（ =.002，η = 0.32）和脱落风险降低（ =.002，η = 0.33），而后者在共患阿片类药物依赖的患者中最强。更高的治疗师依从性预测了社区治疗师（ =.001，η = 0.35）和非单纯自杀/自伤患者（<.001，η = 0.41）随后住院次数减少。相反，更频繁的 NSSI（ =.03，η = 0.22）和更差的整体功能（ =.01，η = 0.26）预测了随后治疗师更高的依从性，后者关系受患者群体的调节。
治疗师的依从性改善了几个关键的患者结果和保留率，突出了按照手册提供 DBT 的依从性的重要性。治疗师可能会发现，对于功能严重受损的患者，更易于坚持 DBT。
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