Therapeutic Alliance in Telephone-Administered Cognitive-Behavioral Therapy for Hematopoietic Stem Cell Transplant Survivors
Therapeutic Alliance in Telephone-Administered Cognitive-Behavioral Therapy for Hematopoietic Stem Cell Transplant Survivors
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DOI：
10.1037/a0027956
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发表时间：
2012-10-01
影响因子：
5.9
通讯作者：
Redd, William H.
中科院分区：
文献类型：
--
作者：
Applebaum, Allison J.;DuHamel, Katherine N.;Redd, William H.
目的：已发现强大的治疗联盟可以预测各种治疗方式和患者群体的心理治疗成功率。然而，只有少数研究将治疗联盟作为癌症幸存者心理治疗结果的预测因子进行了检验，并且没有一个研究在电话认知行为治疗（T-CBT）中检验了这种关系。这项研究评估了治疗联盟对造血干细胞移植（HSCT）（一种治疗某些癌症的方法）幸存者心理治疗结果的影响程度。方法：46 名患者参加了针对创伤后应激障碍 (PTSD) 的 T-CBT 随机临床试验，完成了基线评估（包括 PTSD 症状、抑郁和一般痛苦的自我报告测量）、10 次单独的 T-CBT 疗程以及基线后 6、9 和 12 个月的随访评估。在第三次 T-CBT 会议后，使用工作联盟清单对治疗联盟进行评估，得出总体和子量表（任务、债券和目标）分数。结果：分析显示，较高的治疗联盟总分可以前瞻性地预测抑郁症状的减少；较高的任务得分预示着整体痛苦、抑郁症状、重新体验症状和回避症状的减少；较高的债券分数预示着抑郁症状和重新体验症状的减少。结论：这些结果表明，治疗联盟的评估应纳入常规临床护理，并且应在干预措施中专门培养治疗联盟，以最大限度地提高癌症幸存者等弱势群体的心理治疗效益。
Objective: A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient populations. However, only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors, and none have examined this relation in telephone-administered cognitive-behavioral therapy (T-CBT). This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation (HSCT), a treatment for some cancers. Method: Forty-six patients enrolled in a randomized clinical trial of T-CBT for posttraumatic stress disorder (PTSD) completed a baseline assessment (including self-report measures of PTSD symptoms, depression, and general distress), 10 individual T-CBT sessions, and follow-up assessments at 6, 9, and 12 months post-baseline. Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory, which yields overall and subscale (task, bond, and goal) scores. Results: Analyses revealed that higher total therapeutic alliance scores prospectively predicted decreased depressive symptomatology; higher task scores predicted decreased overall distress, depressive symptomatology, symptoms of re-experiencing, and avoidance; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing. Conclusions: These results suggest that assessments of therapeutic alliance should be incorporated into routine clinical care, and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable populations such as cancer survivors.