Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment.
Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment.
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匹配重要吗？
DOI：
10.1111/j.1360-0443.2007.01754.x
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Longabaugh,Richard
中科院分区：
文献类型：
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作者：
Karno,MitchellP;Longabaugh,Richard
目的本研究评估患者的个人属性与他们接受的门诊心理治疗之间的匹配和不匹配程度的预测效度。设计和参与者根据先前研究中观察到的患者与治疗的交互作用，将酗酒或依赖的患者(n= 137)在四个患者和治疗变量配对中分别被回顾地指定为匹配、不匹配或不匹配。这些配对包括(1)患者抑郁症状和治疗情绪焦点，(2)患者特质愤怒和治疗对抗，(3)患者人际反应和治疗对抗，(4)患者人际反应和治疗结构。测量采用方差分析和Logistic回归分析来评估匹配和不匹配对戒酒天数百分比(PDA)和治疗后一年的康复状况的个体和加性影响。只有两对匹配预示着饮酒频率较低，即治疗情绪重点与患者抑郁症状匹配，治疗结构与患者反应性匹配。匹配似乎优化了其他好的结果，而不匹配有更大的影响大小，并往往预测相对较差的结果。该数据支持治疗后PDA存在错配的相加效应。错配最多的一组比错配较少的一组表现要差得多。几个匹配和不匹配也预测了恢复状态，并发现了一些对相加效应的支持。结论患者属性和治疗之间的不匹配似乎具有严重的后果，并且这种影响随着多个不匹配而被放大。另一方面，比赛虽然有益，但可能不是取得好结果所必需的。
AimsThis study assessed the predictive validity of the level of matching and mismatching between patients' personal attributes and aspects of outpatient psychotherapy they received.Design and participantsOn the basis of patient‐by‐treatment interactions observed for this sample in previous research, patients with alcohol abuse or dependence (n= 137) were designated retrospectively as being matched, unmatched or mismatched on each of four patient and treatment variable pairings. These pairings included (1) patient depressive symptoms and therapy emotion focus, (2) patient trait anger and therapy confrontation, (3) patient interpersonal reactance and therapy confrontation and (4) patient interpersonal reactance and therapy structure.MeasurementsAnalyses of variance and logistic regression were used to assess the individual and additive effects of being matched and mismatched on the percentage of abstinent days (PDA) and recovery status in the year after treatment.FindingsBeing mismatched on any of the four patient–treatment pairings was a significant predictor of more frequent alcohol use post‐treatment. Being matched on only two pairings predicted less frequent alcohol use, namely matches on therapy emotion focus with patient depressive symptoms and therapy structure with patient reactance. Matches appeared to optimize otherwise good outcomes, while mismatches had larger effect sizes and tended to predict relatively poor outcomes. The data supported the presence of an additive effect for mismatches on post‐treatment PDA. The group with the most mismatches fared considerably worse than a group with fewer mismatches. Several matches and mismatches also predicted recovery status, with some support found for additive effects.ConclusionsMismatches between patient attributes and treatment appear to have serious consequences, and this effect is magnified with multiple mismatches. Matches, on the other hand, while beneficial, may not be necessary to achieve good outcomes.