Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany.
Behav Res Ther. 2023 Apr;163:104285. doi: 10.1016/j.brat.2023.104285. Epub 2023 Mar 1.
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
先前的研究表明，在针对各种精神障碍（包括神经性厌食症）的心理治疗中，突跃（SGs）与治疗结果之间存在密切关联。然而，对于促成突跃的因素知之甚少。本研究旨在探讨一般变化机制在神经性厌食症体重相关突跃中的作用。研究数据来自一项针对成人神经性厌食症门诊患者的认知行为疗法（CBT）和聚焦心理动力学疗法（FPT）的随机对照试验。分析了“澄清”（洞察力）、“掌握”（应对）和“治疗关系”这三种一般变化机制的疗程数据。在 99 名体重出现突跃的患者中，将突跃前的疗程与对照（突跃前前）疗程进行了比较。此外，采用倾向评分匹配比较了 44 名突跃患者的突跃前疗程数据与 44 名无突跃患者相应疗程的数据。在突跃前疗程中，患者体验到了更高水平的澄清和掌握，但治疗关系并无改善。与没有突跃的患者相比，出现突跃的患者在突跃/相应疗程中同样体验到了更多的澄清和掌握，但治疗关系并无改善。CBT 和 FPT 在这些效果上没有差异。研究结果表明，一般变化机制对 CBT 和 FPT 治疗神经性厌食症的突跃有一定影响。
