Maras Danijela, Balfour Louise, Lefebvre Monique, Tasca Giorgio A
School of Psychology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON.
School of Psychology, Faculty of Medicine, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON.
Res Psychother. 2022 Sep 1;25(3):634. doi: 10.4081/ripppo.2022.634.
Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.
适应慢性病或残疾会伴随着急性和持续的疾病应激源。诸如情绪困扰和低自我效能感等心理因素在慢性病和残疾中很常见，并且会干扰适应过程以及诸如健康相关生活质量等心理社会结果。跨诊断团体心理治疗可能通过针对混合慢性病和残疾中的共同疾病应激源以及维持心理症状的共同过程，为康复护理中的心理治疗提供一种简洁的方法。依恋理论可以解释结果中的个体差异，并有助于识别健康相关生活质量轨迹不佳风险的个体。2016年至2020年间，109名成年人在一家三级护理物理康复中心参加了一个为期8周的基于过程的接纳与承诺疗法-认知行为疗法（ACT-CBT）心理治疗团体。参与者在治疗前和治疗后完成了情绪困扰、自我效能感、健康相关生活质量和依恋的测量。多层次分析表明，患者在治疗后的大多数结果上都有所改善。治疗前的依恋焦虑与更积极的结果相关。可靠变化指数表明大多数参与者有临床意义的变化，但大多数人并未康复。结果为跨诊断团体干预提供了概念验证，并表明可能需要更长疗程的治疗。结果有待在更大、更多样化的样本以及更稳健的设计中进行重复验证。
