Patient depressive symptoms and therapist focus on emotional material: a new look at project MATCH
Patient depressive symptoms and therapist focus on emotional material: a new look at project MATCH
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DOI：
10.15288/jsa.2003.64.607
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发表时间：
2003-09-01
期刊：
影响因子：
--
通讯作者：
Longabaugh, R
中科院分区：
文献类型：
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作者：
Karno, MP;Longabaugh, R
目的：在Project MATCH中，将治疗方式与患者属性匹配通常不会改善结局。未经测试的是，是否实际的治疗师的行为，无论治疗方式，与病人的属性，以改善结果相互作用。本研究探讨了患者的抑郁症状是否与治疗师关注痛苦的情感材料相互作用，以预测酒精治疗的有效性。根据结果，考虑了两种相互竞争的治疗有效性理论方法。方法：来自普罗维登斯MATCH项目临床研究单位的141名参与者完成了治疗前抑郁症状的自我报告测量。然后通过独立观察者对录像治疗过程的评分来判断治疗师对情感材料的关注。这些患者和治疗变量之间的相互作用作为治疗期间和治疗后第一年戒酒天数（PDA）和重度饮酒天数（PHDD）百分比的预测因子进行了测试。结果如下：在治疗期间和治疗后第一年，患者抑郁症状和治疗师情绪焦点之间的相互作用始终预测PDA和PHDD。对于临床上抑郁症状升高的患者，治疗师对痛苦情绪材料的关注程度较低时，饮酒结果有所改善。相反，当治疗师高度关注情感材料时，抑郁症患者的饮酒结果更差。治疗师的行为并不影响亚临床抑郁症状患者的饮酒结果。结论：抑郁症状和治疗师对情感材料的关注之间的相互作用是酒精治疗有效性的重要预测因素。这些结果似乎支持了一种理论，即患者唤醒的减少是治疗有效性的潜在中介。这些研究结果的一致性和稳健性表明，将实际治疗师行为与患者属性相匹配可能比仅基于治疗方式的匹配更能改善饮酒结果。
Objective: Matching treatment modality to patient attribute generally did not improve outcomes in Project MATCH. Untested was whether actual therapist behaviors, irrespective of treatment modality, interacted with patient attributes to improve outcomes. The present study examined whether patient depressive symptoms interacted with therapist focus on painful emotional material to predict the effectiveness of alcohol treatment. Two competing theoretical approaches to treatment effectiveness were considered in light of the results. Method: A self-report measure of pretreatment depressive symptoms was completed by 141 participants from the Providence Clinical Research Unit of Project MATCH. Therapist focus on emotional material was then judged by independent observer ratings of videotaped treatment sessions. The interaction between these patient and therapy variables was tested as a predictor of percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD) during treatment and over the first year following treatment. Results: The interaction between patient depressive symptoms and therapist emotion focus consistently predicted PDA and PHDD both during treatment and over the first year posttreatment. For patients with clinically elevated depressive symptoms, improved drinking outcomes occurred with a low therapist focus on painful emotional material. Conversely, depressed patients had worse drinking outcomes when the therapist had a high focus on emotional material. Therapist behavior did not affect drinking outcomes for patients with subclinical depressive symptoms. Conclusions: The interaction between depressive symptoms and therapist focus on emotional material was an important predictor of alcohol treatment effectiveness. The results appear to support a theory in which the reduction of patient arousal is a potential mediator of treatment effectiveness. The consistency and robustness of these findings suggest that matching actual therapist behaviors to patient attributes may improve drinking outcomes more than matching based solely on treatment modality.