Stoeten Claudia, de Haan Hein Arnoud, Postel Marloes Gerda, Brusse-Keizer Marjolein, Ter Huurne Elke Daniëlle
Tactus Addiction Care, Deventer, Netherlands.
Mediant, Hengelo, Netherlands.
JMIR Form Res. 2022 Jun 30;6(6):e33813. doi: 10.2196/33813.
In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists.
This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion.
A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion.
For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion.
Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients' confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion.
在饮食失调的面对面治疗中，治疗联盟（TA）是症状减轻和治疗完成的重要预测指标。然而，迄今为止，对于基于网络的认知行为疗法（网络CBT）中的TA及其与症状减轻、治疗完成以及患者与治疗师观点之间的关联知之甚少。
本研究旨在分别调查患者和治疗师在治疗中期和治疗后测量的TA评分；治疗师与患者（治疗完成者和未完成者）在TA评分上的一致程度；以及患者和治疗师的TA评分与饮食失调病理和治疗完成之间的关联。
对一项饮食失调网络CBT干预的随机对照试验数据进行二次分析。参与者为170名女性，其中神经性贪食症患者33例，暴饮暴食症患者68例，未另行指定的饮食失调患者69例；平均年龄为39.6（标准差11.5）岁。使用帮助联盟问卷（HAQ）对TA进行操作化。进行配对t检验以评估从治疗中期到治疗后TA的变化。计算组内相关性以确定患者与治疗师在HAQ评分方面的跨信息者一致性。总共使用2个逐步回归程序（在治疗中期和治疗后）来检查哪些HAQ评分可预测饮食失调病理和治疗完成情况。
对于治疗完成者（128/170，75.3%），患者和治疗师的HAQ总分及HAQ-帮助性得分从治疗中期到治疗后均显著改善。对于未完成者（42/170，24.7%），所有HAQ评分均显著下降。对于所有HAQ量表，患者与治疗师之间的一致性较差。然而，治疗后的一致性略好于治疗中期。治疗中期和治疗后，患者在HAQ帮助性子量表上得分越高，与饮食失调心理病理学程度越低相关。治疗中期患者的HAQ总分与治疗完成之间存在正相关。最后，治疗后患者的HAQ总分及治疗师的治疗后HAQ-帮助性得分与治疗完成呈正相关。
我们的研究表明，网络CBT中的TA可预测饮食失调病理和治疗完成情况。特别重要的是，在预测治疗后饮食失调病理和治疗完成情况时，用HAQ帮助性子量表测量的患者对自身能力的信心。
