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奥地利临床代表性条件下门诊心理治疗的过程与结果:一项正在进行的研究的方案与可行性

Process and outcome of outpatient psychotherapies under clinically representative conditions in Austria: protocol and feasibility of an ongoing study.

作者信息

Schaffler Yvonne, Jesser Andrea, Humer Elke, Haider Katja, Pieh Christoph, Probst Thomas, Schigl Brigitte

机构信息

Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria.

Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria.

出版信息

Front Psychiatry. 2024 Mar 6;15:1264039. doi: 10.3389/fpsyt.2024.1264039. eCollection 2024.

DOI:10.3389/fpsyt.2024.1264039
PMID:38510799
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10951102/
Abstract

BACKGROUND

While most studies assessing psychotherapy efficacy are randomized-controlled trials conducted in research institutions or short clinical treatments, the understanding of psychotherapy effectiveness under regular, clinically representative conditions, particularly in outpatient practice, remains limited. Representative data examining the effectiveness of psychotherapy under real-world conditions in Austria is lacking.

AIMS AND METHODS

This paper introduces a naturalistic observational combined process- and outcome study, implementing a dual-perspective approach through standardised pre- and post-treatment questionnaires and evaluating changes in the therapeutic alliance after each session. Further, semi-structured qualitative interviews aim to illuminate the personal experiences of patients and therapists. The primary objective of the presented study is to discern whether symptoms markedly decrease following therapy. A significant secondary goal is to trace the therapeutic alliance's evolution from both patient and therapist viewpoints, emphasising the alliance-outcome association and gender dynamics within the pairs. This paper discusses the project's feasibility after three years and shares key insights.

DISCUSSION

Recruitment for this study has posed substantial challenges due to psychotherapists' concerns regarding data protection, extensive documentation, and philosophical reservations about the study design. Consequently, we recruited fewer participants than initially planned. Despite these hurdles, qualitative data collection has shown notable success. Given psychotherapists' busy schedules and reluctance to participate, more potent external incentives or a legal obligation may be necessary to encourage participation in future studies.

摘要

背景

虽然大多数评估心理治疗效果的研究都是在研究机构进行的随机对照试验或短期临床治疗,但对于常规的、具有临床代表性的条件下,尤其是门诊实践中的心理治疗效果的了解仍然有限。奥地利缺乏在现实世界条件下检验心理治疗效果的代表性数据。

目的与方法

本文介绍了一项自然观察性的、结合过程与结果的研究,通过标准化的治疗前和治疗后问卷采用双视角方法,并评估每次治疗后治疗联盟的变化。此外,半结构化的定性访谈旨在阐明患者和治疗师的个人经历。本研究的主要目的是判断治疗后症状是否明显减轻。一个重要的次要目标是从患者和治疗师的角度追踪治疗联盟的演变,强调联盟与结果的关联以及配对中的性别动态。本文讨论了该项目在三年后的可行性,并分享了关键见解。

讨论

由于心理治疗师对数据保护、大量文档记录以及对研究设计的哲学保留意见,本研究的招募工作面临了巨大挑战。因此,我们招募的参与者比最初计划的要少。尽管有这些障碍,但定性数据收集取得了显著成功。考虑到心理治疗师日程繁忙且不愿参与,未来的研究可能需要更有力的外部激励措施或法律义务来鼓励参与。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/389e/10951102/f2470b712a2e/fpsyt-15-1264039-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/389e/10951102/01196785a056/fpsyt-15-1264039-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/389e/10951102/f2470b712a2e/fpsyt-15-1264039-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/389e/10951102/01196785a056/fpsyt-15-1264039-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/389e/10951102/f2470b712a2e/fpsyt-15-1264039-g002.jpg

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本文引用的文献

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Common factors, Responsiveness and Outcome in Psychotherapy (CROP): study protocol for a naturalistic prospective cohort study of psychotherapy in Denmark.常见因素、心理治疗反应性和结果(CROP):丹麦自然前瞻性队列研究中对心理治疗的研究方案。
BMJ Open. 2023 Jun 2;13(6):e072277. doi: 10.1136/bmjopen-2023-072277.
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Perceived Barriers and Facilitators to Psychotherapy Utilisation and How They Relate to Patient's Psychotherapeutic Goals.心理治疗使用中感知到的障碍与促进因素及其与患者心理治疗目标的关系。
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The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses.
成人精神障碍的心理治疗和药物治疗效果:近期荟萃分析的伞状综述和荟萃分析评估
World Psychiatry. 2022 Feb;21(1):133-145. doi: 10.1002/wps.20941.
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Examining therapist effects in the alliance-outcome relationship: A multilevel meta-analysis.考察联盟-结果关系中的治疗师效应:一项多层次元分析。
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