Treatment preferences affect the therapeutic alliance: Implications for randomized controlled trials
Treatment preferences affect the therapeutic alliance: Implications for randomized controlled trials
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DOI：
10.1037/0022-006x.75.1.194
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发表时间：
2007-02-01
影响因子：
5.9
通讯作者：
Barber, Jacques P.
中科院分区：
文献类型：
--
作者：
Iacoviello, Brian M.;McCarthy, Kevin Scott;Barber, Jacques P.
研究了治疗偏好对治疗联盟发展的影响。75名患者参加了一项随机对照试验，比较了支持表达心理疗法与舍曲林或安慰剂治疗重度抑郁症的效果。在治疗前和治疗第3、5、9周评估治疗依从性。在最初喜欢心理治疗的患者中，接受心理治疗的患者随着时间的推移，他们的联盟增加了，而接受积极药物或安慰剂的患者则减少了。在倾向于药物治疗的患者中，无论他们接受心理治疗、积极药物治疗还是安慰剂，在联盟发展方面没有差异。即使在控制症状严重程度时，也观察到这些关系。因此，患者的治疗偏好和他们最终接受的治疗的一致性影响了治疗联盟的发展。由于联盟是结果的可靠预测因子，因此在随机对照试验设置中可能需要仔细考虑治疗偏好。
The influence of treatment preferences on the development of the therapeutic alliance was investigated. Seventy-five patients were followed while participating in a randomized controlled trial comparing supportive-expressive psychotherapy with sertraline or pill placebo in the treatment of major depressive disorder. Therapeutic alliance was assessed before treatment and at the 3rd, 5th, and 9th weeks of treatment. Among patients initially preferring psychotherapy, those receiving psychotherapy experienced increases in their alliance over time, whereas those receiving active medication or placebo experienced decreases. Among patients preferring pharmacotherapy, there were no differences in alliance development whether they received psychotherapy, active medication, or placebo. These relations were observed even when controlling for symptom severity. Thus, the congruence of patients' treatment preference and the treatment that they ultimately received influenced the development of the therapeutic alliance. Because alliance is a robust predictor of outcome, treatment preferences may need to be carefully considered in randomized controlled trial settings.