DETERMINANTS OF CHANGE IN COGNITIVE THERAPY FOR DEPRESSION
DETERMINANTS OF CHANGE IN COGNITIVE THERAPY FOR DEPRESSION
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DOI：
10.1007/bf01172968
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发表时间：
1990-10-01
影响因子：
2.8
通讯作者：
FEELEY, M
中科院分区：
文献类型：
--
作者：
DERUBEIS, RJ;FEELEY, M
我们在25名成年门诊患者样本中探究了抑郁症认知疗法的变化过程。不了解治疗结果的评估者聆听治疗过程的录音磁带，并对与治疗师提供的促进性条件（热情、共情等）、患者 - 治疗师关系（治疗同盟）以及治疗师对认知疗法方法的依从性相关的项目进行评分。在因素分析中，依从性分为两个因素。一个因素代表认知疗法中“具体的”、以症状为焦点的方法，在治疗早期评估时可预测随后的症状减轻，但在后期则不能。另一个因素代表焦点不太明确、更“抽象”的讨论，不能预测病情改善。促进性条件和治疗同盟都不能预测评分所涉及的治疗阶段之后发生的变化。然而，在治疗后期，先前的症状减轻可预测治疗同盟。文中强调了用于辨别治疗过程中的行为与治疗结果的时间关系的方法。
We explored the processes of change in cognitive therapy of depression in a sample of 25 adult outpatients. Raters blind to treatment outcome listened to audiotapes of sessions and rated items that pertained to the therapist-offered facilitative conditions (warmth, empathy, etc.); the patient-therapist relationship (the helping alliance); and the therapist''s adherence to the methods of cognitive therapy. Adherence separated into two factors in a factor analysis. One factor, representing "concrete," symptom-focused methods of cognitive therapy, predicted subsequent symptom reduction when assessed early in treatment, but not later. The other factor, representing less focused, more "abstract" discussions, did not predict improvement. Neither did facilitative conditions nor the helping alliance predict change that occurred after the rated session. However, later in treatment, the helping alliance was predicted by prior symptom reduction. Methods used to discern the temporal relations of in-session behavior to outcome are highlighted.