Therapeutic Alliance in a Randomized Clinical Trial for Bulimia Nervosa
Therapeutic Alliance in a Randomized Clinical Trial for Bulimia Nervosa
复制标题
DOI：
10.1037/ccp0000021
复制
发表时间：
2015-06-01
影响因子：
5.9
通讯作者：
Peterson, Carol B.
中科院分区：
文献类型：
--
作者：
Accurso, Erin C.;Fitzsimmons-Craft, Ellen E.;Peterson, Carol B.
目的：本研究旨在探讨神经性贪食症（BN）两种治疗方法联合治疗与疗效之间的时间关系。方法：80名有BN症状的成年人被随机分配到21个整合认知情感治疗（ICAT）或增强认知行为治疗（CBT-E）。暴食症状（即，暴饮暴食和腹泻的频率）进行评估。在第2、8、14次会议和治疗后评估治疗联盟（工作联盟清单）。采用随机截距线性混合模型进行重复测量分析，以确定治疗和患者特征的联盟增长差异。混合效应模型研究了联盟和症状改善之间的关系。结果：总体而言，两种治疗的患者报告了强大的治疗联盟。无论治疗，更大的治疗联盟之间（但不是内）的主题预测更大的减少贪食症的行为，减少贪食症的行为也预测改善联盟。抑郁、焦虑或情绪失调程度较高的患者在CBT-E中的治疗联盟比ICAT更强，而那些有更多亲密问题的患者在ICAT中的治疗联盟比CBT-E有更大的改善。结论：治疗联盟对结果有独特的影响，独立于症状改善对联盟的影响。受试者内和受试者间的影响表明，随着时间的推移，联盟的变化并不能预测症状的改善，而是具有更强联盟的个体总体上具有更好的暴食症症状结果。这些发现表明，治疗联盟是BN治疗结果的重要预测因素。
Objective: This study examined the temporal relation between therapeutic alliance and outcome in two treatments for bulimia nervosa (BN). Method: Eighty adults with BN symptoms were randomized to 21 sessions of integrative cognitive-affective therapy (ICAT) or enhanced cognitive-behavioral therapy (CBT-E). Bulimic symptoms (i.e., frequency of binge eating and purging) were assessed at each session and posttreatment. Therapeutic alliance (Working Alliance Inventory) was assessed at Sessions 2, 8, 14, and posttreatment. Repeated-measures analyses using linear mixed models with random intercepts were conducted to determine differences in alliance growth by treatment and patient characteristics. Mixed-effects models examined the relation between alliance and symptom improvement. Results: Overall, patients in both treatments reported strong therapeutic alliances. Regardless of treatment, greater therapeutic alliance between (but not within) subjects predicted greater reductions in bulimic behavior; reductions in bulimic behavior also predicted improved alliance. Patients with higher depression, anxiety, or emotion dysregulation had a stronger therapeutic alliance in CBT-E than ICAT, while those with more intimacy problems had greater improvement in therapeutic alliance in ICAT compared to CBT-E. Conclusions: Therapeutic alliance has a unique impact on outcome, independent of the impact of symptom improvement on alliance. Within-and between-subjects effects revealed that changes in alliance over time did not predict symptom improvement, but rather that individuals who had a stronger alliance overall had better bulimic symptom outcomes. These findings indicate that therapeutic alliance is an important predictor of outcome in the treatment of BN.