A case study of mediators of treatment effectiveness.
A case study of mediators of treatment effectiveness.
复制标题
治疗效果中介因素的案例研究。
DOI：
10.1111/j.1530-0277.2007.00491.x
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Karno,MitchellP
中科院分区：
文献类型：
--
作者：
Karno,MitchellP
背景：最近的研究观察到，在酒精滥用或依赖的心理社会治疗中使用对抗对处于平均或高于平均特质愤怒水平的患者的治疗后酒精使用产生负面影响。不知道是什么引起了这种负面影响。目前的研究探讨了会议出席的作用，作为一个调解人的影响，对抗患者随后的酒精使用。在这样做的过程中，该研究展示了测试调解以及规划分析，以满足额外的条件，可以提供支持的因果机制的changes.Methods：多元回归分析被用来测试会话出席率作为一个调解员之间的107个人与酒精滥用或依赖接受认知行为疗法（CBT）（n=39），动机增强疗法（MET）（n=34），或十二步促进疗法（TSF）（n=34）。重点放在实现所需的时间序列的治疗干预，调解人，和outcome variable.Results：数据支持的作用，会议出席作为一个部分调解人的对抗对未来的酒精使用的患者接受CBT的影响，但不是在接受MET或TSF的患者。在CBT中，其他潜在的介质（例如，治疗联盟和会话阻力）不受支持，并且没有改变模型中对会话出席的支持。除了调解，一些，但不是所有的标准的因果机制的变化也mapped.Conclusions：本研究表明，在CBT的负面影响的对抗早期治疗的部分原因是减少会议的病人参加。MET和TSF似乎正在发生不同的过程。通过仔细构建分析模型，结果既可以说明调解问题，也可以说明变化的因果机制。
Background:Recent research has observed that the use of confrontation in psychosocial treatment for alcohol abuse or dependence has a negative effect on posttreatment alcohol use among patients at average or above average levels of trait anger. It is not known what mediates that negative effect. The current study examines the role of session attendance as a mediator of the effect of confrontation on patients’ subsequent alcohol use. In doing so, the study demonstrates the process of testing for mediation as well as planning analyses to meet additional conditions that can lend support to a causal mechanism of change.Methods:Multiple regression analyses were used to test for session attendance as a mediator among 107 individuals with alcohol abuse or dependence who received either cognitive behavioral therapy (CBT) (n=39), motivational enhancement therapy (MET) (n=34), or twelve‐step facilitation therapy (TSF) (n=34). Emphasis was placed on achieving the desired temporal sequence of the therapy intervention, the mediator, and the outcome variable.Results:The data supported the role of session attendance as a partial mediator of the effect of confrontation on future alcohol use among patients who received CBT, but not among patients who received MET or TSF. In CBT, other potential mediators (e.g., therapeutic alliance and in‐session resistance) were not supported and did not change the support for session attendance in the model. Beyond mediation, some but not all criteria for a causal mechanism of change were also met.Conclusions:This study suggests that in CBT the negative impact of confrontation early in treatment is partially explained by a reduction in the number of sessions patients attended. Different processes appear to be occurring in MET and TSF. By carefully constructing analytic models, results can speak both to issues of mediation and to causal mechanisms of change.