Wolf Nadja, van Oppen Patricia, Hoogendoorn Adriaan W, van Balkom Anton J L M, Visser Henny A D
Mental Health Care Institute Geestelijke gezondheidszorg (GGZ) Centraal, Amersfoort, Netherlands.
Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands.
Front Psychiatry. 2022 Mar 24;13:658693. doi: 10.3389/fpsyt.2022.658693. eCollection 2022.
Therapeutic alliance has consistently been found to predict treatment outcomes across various psychotherapies and patient diagnosis. However, the relationship between therapeutic alliance and outcome in Cognitive Behavioral Therapy (CBT) has shown mixed results. This study investigated the impact of different aspects of therapeutic alliance in CBT for Obsessive-Compulsive Disorder (OCD).
Data from two previously completed randomized controlled trials of 208 patients with OCD and their therapists were analyzed. Therapeutic alliance was assessed at week 4 of treatment with the patient-rated and therapist-rated Working Alliance Inventory (WAI), which includes three subscales to measure alliance domains (Goal, Task and Bond). Higher WAI score reflects a better therapeutic relationship. OCD severity was rated by independent assessors at baseline and post-treatment using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Linear regression analyses were used to examine the effects of the different aspects of therapeutic alliance on treatment outcome, adjusted for baseline symptom severity.
A higher total WAI score as rated by therapists significantly predicted a lower post-treatment Y-BOCS. Further, higher scores on the Goal and Task subscales of the WAI were associated with lower post-treatment severity. However, these significant outcomes reflected only small effect sizes.
In the treatment of OCD, the strength of the therapeutic alliance contributes to outcomes, though to a limited extent. Effective OCD treatment involves the delivery of specific therapy interventions, in the context of a strong therapeutic alliance.
一直以来，治疗联盟被发现能够预测各种心理治疗及患者诊断的治疗结果。然而，治疗联盟与认知行为疗法（CBT）结果之间的关系呈现出复杂的结果。本研究调查了治疗联盟不同方面在强迫症（OCD）的认知行为疗法中的影响。
分析了来自两项先前完成的针对208名强迫症患者及其治疗师的随机对照试验的数据。在治疗第4周时，使用患者自评和治疗师自评的工作联盟量表（WAI）评估治疗联盟，该量表包括三个子量表以测量联盟领域（目标、任务和纽带）。WAI得分越高反映治疗关系越好。强迫症严重程度由独立评估者在基线和治疗后使用耶鲁-布朗强迫症量表（Y-BOCS）进行评定。使用线性回归分析来检验治疗联盟不同方面对治疗结果的影响，并对基线症状严重程度进行了校正。
治疗师评定的WAI总分较高显著预测了治疗后较低的Y-BOCS得分。此外，WAI的目标和任务子量表得分较高与治疗后较低的严重程度相关。然而，这些显著结果仅反映了较小的效应量。
在强迫症治疗中，治疗联盟的强度对结果有贡献，尽管程度有限。有效的强迫症治疗需要在强大的治疗联盟背景下提供特定的治疗干预措施。
