Outcomes, skill acquisition, and the alliance: Similarities and differences between clinical trial and student therapists.
Outcomes, skill acquisition, and the alliance: Similarities and differences between clinical trial and student therapists.
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DOI：
10.1016/j.brat.2020.103608
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发表时间：
2020-03
影响因子：
4.1
通讯作者：
Lizabeth A Goldstein;Abby D Adler Mandel;R. DeRubeis;Daniel R. Strunk
中科院分区：
文献类型：
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作者：
Lizabeth A Goldstein;Abby D Adler Mandel;R. DeRubeis;Daniel R. Strunk
来自临床试验的大量证据支持认知疗法（CT）对抑郁症的疗效。当在其他情况下提供时，例如由学生治疗师提供时，对结果知之甚少。我们进行了一项非随机比较学生治疗师与临床试验治疗师的抑郁症状的变化，辍学，CT技能的变化，和治疗联盟之间的100名中度至重度抑郁症的客户。治疗手册和持续时间相同。由学生治疗师治疗的客户在抑郁症状变化、治疗联盟和CT技能方面的结果基本相当。结果支持非劣效性的学生治疗师的抑郁症状的变化，但不支持非劣效性时，使用一个采访者评估抑郁症的措施。还获得了客户CT技能和治疗联盟的非劣效性证据。事实上，传统的优势分析表明，学生治疗师优于临床试验治疗师的联盟和CT技能。学生治疗师的辍学率（30%）在数字上高于临床试验治疗师（17%），我们的结果并不支持辍学的非劣效性。由学生治疗师提供的CT可以达到与临床试验相似的结果，但需要更多关于辍学的研究。
Considerable evidence from clinical trials supports the efficacy of cognitive therapy (CT) of depression. Less is known about outcomes when provided in other contexts, such as when provided by student therapists. We conducted a non-randomized comparison of student therapists vs. clinical trial therapists on change in depressive symptoms, dropout, change in CT skills, and therapeutic alliance among 100 clients with moderate to severe depression. Treatment manual and duration were the same. Clients treated by student therapists had largely comparable outcomes on depressive symptom change, therapeutic alliance, and CT skills. Results supported non-inferiority of student therapists on change in depressive symptoms, but non-inferiority was not supported when using an interviewer evaluated measure of depression. Evidence of non-inferiority was also obtained for client CT skills and therapeutic alliance. In fact, conventional superiority analyses indicated student therapists outperformed clinical trial therapists on alliance and CT skills. The rate of dropout among student therapists (30%) was numerically higher than among clinical trial therapists (17%) and our results did not support non-inferiority on dropout. CT provided by student therapists can achieve outcomes similar to those in a clinical trial, but more research about dropout is needed.