Relatives' Emotional Involvement Moderates the Effects of Family Therapy for Bipolar Disorder
Relatives' Emotional Involvement Moderates the Effects of Family Therapy for Bipolar Disorder
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DOI：
10.1037/a0037713
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发表时间：
2015-02-01
影响因子：
5.9
通讯作者：
Miklowitz, David J.
中科院分区：
文献类型：
--
作者：
Fredman, Steffany J.;Baucom, Donald H.;Miklowitz, David J.
目的：发现情绪表达结构的“批评评论”维度对双相情感障碍患者的病程有预测作用，但对“情绪过度投入”维度的预测作用尚不明确。本研究的目的是评估亲属观察到的适当和不适当的情感介入（侵入性、自我牺牲和对患者福祉的痛苦）是否会调节以家庭为基础的双相情感障碍干预的有效性。方法：来自两项临床试验的108例双相情感障碍患者（平均年龄35.61岁，SD = 10.07； 57%为女性）及其亲属（62%为配偶）在接受药物治疗加家庭治疗（FBT）或简短心理教育（危机管理[CM]）之前完成了10分钟的问题解决互动。在2年内每3-6个月对患者进行一次访谈，以评估情绪症状。结果：当亲属表现出低水平的不适当自我牺牲时，CM和FBT在2年内都与患者躁狂症状的改善有关。当亲属表现出高水平时，CM患者随着时间的推移变得更加躁狂，而FBT患者则变得不那么躁狂。在高水平的不适当情绪反应中也观察到躁狂轨迹的组间差异，而在低水平上则没有。当亲属表现出高度适当的自我牺牲时，两组患者的抑郁程度都有所减轻。在低水平的适当自我牺牲中，CM患者没有改善，而FBT患者的抑郁程度有所减轻。结论：未来的双相情感障碍研究应考虑亲属对患者的情感参与的数量和适当性以及他们的关键行为的预后价值。
Objective: The "critical comments" dimension of the expressed emotion (EE) construct has been found to predict the illness course of patients with bipolar disorder, but less is known about the "emotional overinvolvement" component. The goal of this study was to evaluate whether relatives' observed appropriate and inappropriate emotional involvement (intrusiveness, self-sacrifice, and distress about patients' well-being) moderated the effectiveness of a family-based intervention for bipolar disorder. Method: 108 patients with bipolar disorder (mean age = 35.61 years, SD = 10.07; 57% female) and their relatives (62% spouses) from 2 clinical trials completed 10-min problem-solving interactions prior to being treated with pharmacotherapy plus family-based therapy (FBT) or brief psychoeducation (crisis management [CM]). Patients were interviewed every 3-6 months over 2 years to assess mood symptoms. Results: When relatives showed low levels of inappropriate self-sacrifice, CM and FBT were both associated with improvements in patients' manic symptoms over 2 years. When relatives showed high levels, patients in CM became more manic over time, whereas patients in FBT became less manic. Group differences in mania trajectories were also observed at high levels of inappropriate emotional response but not at low. When relatives showed high levels of appropriate self-sacrifice, patients in both groups became less depressed. At low levels of appropriate self-sacrifice, patients in CM did not improve, whereas patients in FBT became less depressed. Conclusions: Future studies of bipolar disorder should consider the prognostic value of the amount and appropriateness of relatives' emotional involvement with patients in addition to their critical behaviors.