Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression
Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression
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DOI：
10.1037/ccp0000055
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发表时间：
2016-01-01
影响因子：
5.9
通讯作者：
Holmqvist, Rolf
中科院分区：
文献类型：
--
作者：
Ekeblad, Annika;Falkenstrom, Fredrik;Holmqvist, Rolf
目的：尽管心理治疗中心理化的概念受到了相当多的关注，但将心理化作为心理治疗过程和结果的预测因子的研究却很少。我们利用一项针对抑郁症的认知行为疗法和人际心理疗法的随机对照试验的数据，根据《精神疾病诊断与统计手册》研究了 85 名重度抑郁症 (MDD) 门诊患者的心理化情况。据推测，心智化能力较低的患者会经历较差的联盟质量和较差的结果。方法：使用 Beck 抑郁量表 II 测量每次治疗的抑郁症状。心理化是通过稍微缩短版的成人依恋访谈中的反思功能（RF）来衡量的。还使用了抑郁症特异性反射功能（DSRF）的测量方法，即测量有关抑郁症状的心理化程度。每次治疗后，治疗师和患者都会完成工作联盟清单-修订版。使用纵向多级建模来分析数据。结果：患者的平均 RF 非常低（M = 2.62，SD = 1.22）。较低的治疗前 RF/DSRF 预示着治疗期间治疗师评价的工作联盟会显着降低。 RF 不影响患者评价的联盟，但较低的 DSRF 预示着整个治疗过程中患者评价的联盟较低。 RF/DSRF 较高的患者自评抑郁症的结果较好。结论：研究结果显示重度抑郁症患者的心智化能力低于正常水平。较低的 RF/DSRF 预示着较差的治疗结果。需要更多的研究来了解 RF 如何影响心理治疗反应以及 RF 在抑郁症康复后如何受到影响。
Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.