创伤后应激障碍的延长暴露和舍曲林治疗中与创伤相关的信念和治疗联盟变化的时间顺序。
Temporal sequencing of change in trauma-related beliefs and therapeutic alliance during prolonged exposure and sertraline for chronic PTSD.
机构信息
PTSD Treatment and Research Program, Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA.
Center for Anxiety and Traumatic Stress, Department of Psychology, University of Washington, Seattle, WA, USA.
出版信息
Psychother Res. 2024 Jan;34(1):17-27. doi: 10.1080/10503307.2023.2184733. Epub 2023 Mar 13.
OBJECTIVE
Changes in trauma-related beliefs and therapeutic alliance have been found to temporally precede symptom reduction; however, it is likely these processes do not act in isolation but rather in interactive ways.
METHODS
The present study examined the temporal relationships between negative posttraumatic cognitions (PTCI) and therapeutic alliance (WAI) in 142 patients who were part of a randomized trial comparing prolonged exposure (PE) to sertraline for chronic PTSD.
RESULTS
Using time-lagged mixed regression models, improvements in the therapeutic alliance predicted subsequent improvements in trauma-related beliefs (= 0.59), an effect accounted for by between-patient variability (= 0.64) compared to within-patient variability ( = .04) giving weaker support to the causal role of alliance on outcome. Belief change did not predict improvements in alliance and neither model was moderated by treatment type.
CONCLUSION
Findings suggest alliance may not be an independent driver of cognition change and point to the need for additional study of the impact of patient characteristics on treatment processes.
目的
创伤相关信念和治疗联盟的变化被发现先于症状减轻而发生；然而，这些过程很可能不是孤立作用，而是以交互的方式起作用。
方法
本研究在一项比较延长暴露（PE）与舍曲林治疗慢性 PTSD 的随机试验中，调查了 142 名患者的创伤后认知（PTCI）和治疗联盟（WAI）之间的时间关系。
结果
使用时滞混合回归模型，治疗联盟的改善预测了随后创伤相关信念的改善（=0.59），这一效应归因于患者间的可变性（=0.64），而不是患者内的可变性（=0.04），这对联盟对结果的因果作用的支持较弱。信念的变化并不能预测联盟的改善，而且这两种模式都不受治疗类型的调节。
结论
研究结果表明，联盟可能不是认知变化的独立驱动因素，并指出需要进一步研究患者特征对治疗过程的影响。
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