Leveraging observational data to identify in-session patient and therapist predictors of cognitive processing therapy response and completion.
Leveraging observational data to identify in-session patient and therapist predictors of cognitive processing therapy response and completion.
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DOI：
10.1002/jts.22924
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发表时间：
2023-03
影响因子：
3.3
通讯作者：
Elizabeth Alpert;Joseph K. Carpenter;Brian N Smith;Mercedes G. Woolley;Chelsea Raterman;Courtney C Farmer;S. Kehle-Forbes;T. Galovski
中科院分区：
文献类型：
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作者：
Elizabeth Alpert;Joseph K. Carpenter;Brian N Smith;Mercedes G. Woolley;Chelsea Raterman;Courtney C Farmer;S. Kehle-Forbes;T. Galovski
认知加工疗法（CPT）是一种循证治疗创伤后应激障碍（PTSD），但鲜为人知的是，在会话过程中的变量，预测症状减轻和治疗完成CPT。检查可能促进或阻碍康复的潜在可塑性因素可以为护理提供信息并提高结果。本研究使用CPT会话记录的观察评级来检查会话中患者和治疗师在认知，情感和人际领域的因素，以确定其对预测症状结果和治疗完成的相对贡献。参与者是70名接受CPT的人际暴力成年幸存者。较好的治疗后PTSD结果的预测因素包括患者较少的恐惧，β = 0.32，以及患者较少回避与治疗师接触，β = 0.35。当使用最后一次可用的PTSD评分时，较少的恐惧，β = 0.23，回避，β = 0.28，继续预测更好的结果，更多的患者认知灵活性成为更强的结果预测因子，β =-0.33。更高的治疗完成的可能性的预测因素包括更多的治疗师使用苏格拉底对话，OR = 6.75，和治疗师鼓励患者的影响，OR = 0.11。患者的悲伤和愤怒以及治疗师的同情表达并不能预测症状结果或治疗完成与退出。结果突出了患者的认知，情绪，并与他们的治疗师在CPT的参与，以及治疗师的行为在患者完成治疗的作用的重要性。
Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD), but little is known about in-session process variables that predict symptom reduction and treatment completion during CPT. Examining potentially malleable factors that may promote or impede recovery can inform care delivery and enhance outcomes. The current study used observational ratings of CPT session recordings to examine in-session patient and therapist factors in cognitive, affective, and interpersonal domains to identify their relative contributions to predicting symptom outcomes and treatment completion. Participants were 70 adult survivors of interpersonal violence who received CPT. Predictors of better posttreatment PTSD outcomes included less patient fear, β = .32, and less patient avoidance of engaging with the therapist, β = .35. When using the last available PTSD score, less fear, β = .23, and avoidance, β = .28, continued to predict better outcomes, and more patient cognitive flexibility emerged as a stronger predictor of outcome, β = -.33. Predictors of a higher likelihood of treatment completion included more therapist use of Socratic dialogue, OR = 6.75, and less therapist encouragement of patient affect, OR = 0.11. Patient sadness and anger and therapist expression of empathy did not predict symptom outcomes or treatment completion versus dropout. The results highlight the importance of patients' cognitions, emotions, and engagement with their therapist in CPT as well as the role of therapist behaviors in patient completion of treatment.