基于互联网的妊娠丢失后治疗中工作联盟的变化及其与治疗结果的关联。
The change of working alliance and the association to treatment outcome in an internet-based therapy after pregnancy loss.
机构信息
Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
出版信息
BMC Psychol. 2024 May 7;12(1):254. doi: 10.1186/s40359-024-01751-4.
BACKGROUND
Working alliance is a prominent non-specific factor for treatment outcomes in face-to-face and internet-based interventions. The association between working alliance and therapy outcome appears to be time- and disorder-specific, but less is known about the change of working alliance during the intervention and the impact of working alliance in grief-specific interventions. The present study examines the association between the change of working alliance and treatment outcomes in an internet-based intervention for parents who experienced pregnancy loss.
METHODS
228 participants received a grief intervention based on cognitive behavioral therapy with asynchronous text-based therapist feedback. Prolonged grief and related symptoms of traumatic stress, depression, anxiety, and general psychopathology were assessed with validated instruments before and after the intervention. The change of working alliance was assessed using the short version of the Working Alliance Inventory at mid-treatment (session 4) and the end of the treatment (session 10).
RESULTS
Data for N = 146 persons was analyzed. Working alliance in total and all subscales increased significantly from sessions 4 to 10. This change in working alliance correlated significantly with a reduction in prolonged grief. Changes in subscales of working alliance also correlated with symptoms of depression and general psychopathology. Regression analysis showed that a change in working alliance predicted a reduction in prolonged grief but did not predict improvements in other grief-related symptoms.
CONCLUSION
The results examine the change of working alliance during an internet-based intervention and the association with treatment outcome. A small impact of change in working alliance on treatment outcome of prolonged grief was confirmed, but not on related symptoms. Further research is needed to assess moderators of the alliance-outcome association to improve internet-based interventions.
TRIAL REGISTRATION
Not applicable.
背景
工作联盟是面对面和基于互联网的干预治疗结果的重要非特异性因素。工作联盟与治疗结果之间的关联似乎具有时间和疾病特异性，但对于干预过程中工作联盟的变化以及工作联盟在特定于悲伤的干预中的影响知之甚少。本研究探讨了基于认知行为疗法的互联网干预中，经历妊娠丧失的父母的工作联盟变化与治疗结果之间的关系。
方法
228 名参与者接受了基于认知行为疗法的悲伤干预，其中包括异步文本形式的治疗师反馈。在干预前后，使用经过验证的工具评估了创伤后应激、抑郁、焦虑和一般精神病理学相关的延长悲伤和相关症状。在治疗中期（第 4 次治疗）和治疗结束时（第 10 次治疗）使用工作联盟量表的简短版本评估工作联盟的变化。
结果
对 N=146 人的数据进行了分析。工作联盟的总分和所有子量表从第 4 次治疗到第 10 次治疗均显著增加。工作联盟的这种变化与延长悲伤的减少显著相关。工作联盟子量表的变化也与抑郁和一般精神病理学症状相关。回归分析显示，工作联盟的变化可以预测延长悲伤的减少，但不能预测其他与悲伤相关的症状的改善。
结论
研究结果检验了基于互联网的干预过程中工作联盟的变化及其与治疗结果的关系。确认了工作联盟变化对延长悲伤治疗结果的小影响，但对相关症状没有影响。需要进一步研究来评估联盟-结果关联的调节因素，以改进基于互联网的干预措施。
试验注册
不适用。
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