Working alliance and empathy as mediators of brief telephone counseling for cigarette smokers who are not ready to quit.
Working alliance and empathy as mediators of brief telephone counseling for cigarette smokers who are not ready to quit.
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DOI：
10.1037/adb0000243
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发表时间：
2017-02
期刊：
影响因子：
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通讯作者：
Solomon LJ
中科院分区：
文献类型：
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作者：
Klemperer EM;Hughes JR;Callas PW;Solomon LJ
工作联盟和共情被认为是咨询的重要组成部分，但很少有研究进行实证检验。我们最近进行了一项随机对照试验，其中与常规护理相比，简短的动机和减少咨询未能增加尝试戒烟（QA）的参与者数量（即，简单建议退出）。我们的负面发现可能是由于非特异性因素。该二次分析使用了一个参与者子集（n=347）来测试a）与常规护理相比，基于电话的简短激励或减少咨询是否预测了更大的工作联盟或同理心，B）这些非特异性因素的变化是否预测了6个月随访时QA的概率增加，以及c）咨询是否通过工作联盟或同理心影响QA的概率（即，调解）。结果是相似的两个积极的咨询条件（动机和减少）与常规护理。与常规护理相比，积极的咨询预测了更大的工作联盟（p<.001）和同理心（p<.05）。更大的工作联盟预测了更大的QA概率（p<.001），但令人惊讶的是，更大的同理心预测了6个月随访时QA概率的降低（p<.05）。工作联盟（p<0.001）和共情（p<0.05）均介导了积极咨询对QA概率的影响。与常规护理相比，我们的激励和减少干预措施未能影响QA的一个解释是，工作联盟和同理心对戒烟有相反的影响。我们的分析说明了如何测试非特异性因素作为介质可以帮助解释为什么治疗失败。
Working alliance and empathy are believed to be important components of counseling, though few studies have empirically tested this. We recently conducted a randomized controlled trial in which brief motivational and reduction counseling failed to increase the number of participants who made a quit attempt (QA) in comparison to usual care (i.e., brief advice to quit). Our negative findings could have been due to non-specific factors. This secondary analysis used a subset of participants (n=347) to test a) whether, in comparison to usual care, brief telephone-based motivational or reduction counseling predicted greater working alliance or empathy, b) whether changes in these non-specific factors predicted an increased probability of a QA at a 6-month follow-up, and c) whether counseling affected the probability of a QA via working alliance or empathy (i.e., mediation). Findings were similar for both active counseling conditions (motivational and reduction) vs usual care. In comparison to usual care, active counseling predicted greater working alliance (p<.001) and empathy (p<.05). Greater working alliance predicted a greater probability of a QA (p<.001) but, surprisingly, greater empathy predicted a decreased probability of a QA (p<.05) at the 6-month follow-up. Both working alliance (p<.001) and empathy (p<.05) mediated the active counseling's effects on the probability of a QA. One explanation for our motivational and reduction interventions' failure to influence QAs in comparison to usual care is that working alliance and empathy had opposing effects on quitting. Our analyses illustrate how testing non-specific factors as mediators can help explain why a treatment failed.