Schauenburg H, Strack M
Klinik für Psychosomatik und Psychotherapie, Universität Göttingen.
Psychother Psychosom Med Psychol. 1998 Jul;48(7):257-64.
After a long period of discussions on the efficacy of psychotherapy, there is still a lack of conventions for measuring change after psychological treatment. This paper first describes the concept of statistical and clinical significance of change. Using the SCL-90-R as a commonly administered instrument we then propose conventions and cut-off points for its global severity score (GSI) and change after therapy. A German standard population and several psychotherapy samples were aggregated to determine cut-off points and confidence intervals (reliable change indices) for statistically and clinically significant changes. Tingey et al. (1996) proposed the use of multiple clinical groups (inpatients and outpatients) aiming at a more realistic determination of "stepwise" changes. We examined this procedure with our data. Results show that it is not applicable in the German samples collected so far. Initial SCL-90-R scores in these groups did not differentiate sufficiently between inpatients and outpatients. Therefore, according to Jacobson and Truax (1991), moving from a "functional" to a "dysfunctional" population is still the criterion for a clinically significant change.
在对心理治疗的疗效进行了长时间的讨论之后，心理治疗后变化的测量仍缺乏规范。本文首先描述了变化的统计学意义和临床意义的概念。我们以常用的SCL-90-R量表为例，提出了其总体严重程度评分（GSI）及治疗后变化的规范和临界点。汇总了德国标准人群和几个心理治疗样本的数据，以确定具有统计学意义和临床意义变化的临界点及置信区间（可靠变化指数）。廷吉等人（1996年）建议使用多个临床组（住院患者和门诊患者），旨在更实际地确定“逐步”变化。我们用我们的数据检验了这个程序。结果表明，它不适用于迄今收集的德国样本。这些组的SCL-90-R初始分数在住院患者和门诊患者之间没有足够的区分度。因此，根据雅各布森和特鲁克斯（1991年）的观点，从“功能正常”人群转变为“功能失调”人群仍然是临床显著变化的标准。
