How does hostile resistance interfere with the benefits of cognitive-behavioral therapy for panic disorder? The role of therapist adherence and working alliance.
How does hostile resistance interfere with the benefits of cognitive-behavioral therapy for panic disorder? The role of therapist adherence and working alliance.
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DOI：
10.1080/10503307.2022.2044086
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发表时间：
2022-11
影响因子：
3.9
通讯作者：
Barber, Jacques P.
中科院分区：
文献类型：
--
作者：
Schwartz, Rachel A.;McCarthy, Kevin S.;Solomonov, Nili;Chambless, Dianne L.;Milrod, Barbara;Barber, Jacques P.
关键词：
尽管来访者对治疗师的敌意行为（敌意抵抗）预示着恐慌症认知行为疗法（CBT）的结果会更差，但这种情况发生的过程仍然未知。本研究探讨了两种假定的机制：工作联盟和治疗师依从性。在一项更大规模的试验中，71 名患有原发性恐慌症的成年人接受了 CBT。第 2 节和第 10 节中的敌对抵抗和坚持使用观察员评级的措施进行了可靠编码；客户和治疗师评分的问卷评估了工作联盟。结果指标是自然减员和症状改善，用恐慌症严重程度量表在多个时间点进行评估。敌对抵抗与工作联盟中先前存在的 (r = -.36, p = .04) 和随后的下降 (r = -.58, p < .0001) 显着相关。然而，分层线性模型显示，联盟的下降和治疗师的依从性（无论是线性还是曲线）都不能独立预测症状变化，这些因素也不能介导敌对抵抗与较差的症状改善之间的关联。探索性逻辑回归同样表明，坚持或联盟都不会调节敌对抵抗的客户是否退出。这是第一项建立敌对抵抗与日渐衰落的工作联盟之间双向关联的研究。研究结果还增加了关于依从性与结果关系的混合文献。
Although clients’ hostile behavior directed at therapists (hostile resistance) predicts worse outcomes in cognitive-behavioral therapy (CBT) for panic disorder, the process by which this happens remains unknown. This study examines two putative mechanisms: working alliance and therapist adherence. Seventy-one adults with primary panic disorder received CBT in a larger trial. Hostile resistance and adherence in Sessions 2 and 10 were reliably coded using observer-rated measures; client- and therapist-rated questionnaires assessed working alliance. Outcome measures were attrition and symptomatic improvement, assessed at multiple timepoints with the Panic Disorder Severity Scale. Hostile resistance was significantly related to both preexisting (r = −.36, p = .04) and subsequent declines (r = −.58, p < .0001) in the working alliance. Nevertheless, hierarchical linear modeling revealed that neither a declining alliance nor therapist adherence (whether treated as linear or curvilinear) was independently predictive of symptom change, nor did these factors mediate hostile resistance’s association with worse symptomatic improvement. Exploratory logistic regressions similarly indicated that neither adherence nor alliance moderated whether hostilely resistant clients dropped out. This is the first study to establish a bidirectional association between hostile resistance and a declining working alliance. Findings also add to a mixed literature on the adherence-outcome relationship.
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