Alliance-Focused Training (AFT) as an integrative approach to improve therapists’ competencies in dealing with alliance ruptures and prevent negative outcome in psychotherapy for depression. A randomized controlled multicenter trial

联盟聚焦培训 (AFT) 作为一种综合方法，可提高治疗师处理联盟破裂的能力，并防止抑郁症心理治疗出现负面结果。

• 批准号: 504346851
• 负责人: Professorin Dr. Antje Gumz
• 金额: --
• 依托单位: Psychologische Hochschule Berlin gGmbH (PHB)
• 依托单位国家: 德国
• 项目类别: Clinical Trials
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/504346851?language=en
• 关键词: Alliance; Focused; Training; AFT; integrative

Depressive disorders are among the most common disorders and constitute the leading cause for disability worldwide. Psychotherapy is recommended as one of the main evidence-based treatments. However, many patients with depression do not benefit enough and about 1/3 terminates psychotherapy prematurely. Factors closely linked to outcome and dropout, such as the therapeutic alliance, need to be addressed. Ruptures in the therapeutic alliance (i.e. periods of tension or breakdown) inevitably occur in the course of any psychotherapy. They constitute a high risk of premature treatment termination and poor therapy outcome. Therapists often fail to notice them or lack the skills to deal with them constructively. Despite the common occurrence of alliance ruptures and the serious implications resulting from failures to resolve them, the curricula of psychotherapy training do not systematically address the topic as of yet. The alliance-focused training (AFT) is a promising approach to enhance therapists’ skills in dealing with alliance ruptures, independent of psychotherapeutic orientation, using video recordings of therapy sessions and role play as central elements. Previous research including an own pilot study (funded by the Heigl Foundation) emphasizes the potential of the approach. However, evidence from large-scale trials is missing. The project intends to investigate the effectiveness of AFT (vs. psychotherapy training as usual, TAU) for depressed patients (planned n=232) and their trainee therapists (Cognitive-behavioral, CBT or Psychodynamic psychotherapy, PDT; planned n=116) in a randomized controlled multicenter trial, stratified by cooperating center (n=11 psychotherapy training institutes), treatment approach (CBT vs. PDT), and comorbid personality disorder. Therapy sessions (50 min.) will take place once a week, post-assessment will be performed after 20 weeks and 1st follow-up after 35 weeks. The two hierarchically ordered primary hypotheses are: In AFT compared to TAU, a stronger reduction of self-rated depressive symptoms (first primary endpoint) and a lower rate of patient dropout (second primary endpoint) is expected after 20 weeks. Secondary outcome parameters are: other measurement points of self-rated depressive symptoms and dropout, observer-rated depressive symptoms; self-rated anxiety, somatic complaints, personality structure and interpersonal problems, and quality of life for patients, as well as therapeutic competence and higher satisfaction with supervision for therapists. In addition, evidence-based mediators will be investigated. The proposed project focuses on one of the most prevalent disorders, is dedicated to a topic highly relevant to everyday practice, and uses a randomized-controlled multi-center design including 11 training institutes throughout Germany. Thus, the results have great potential to substantially contribute to an evidence-based psychotherapy training and improved outcomes for patients with depression.

抑郁症是最常见的疾病之一，也是全世界残疾的主要原因。心理治疗被推荐为主要的循证治疗方法之一。然而，许多抑郁症患者并没有获得足够的益处，大约有1/3的患者提前终止了心理治疗。需要解决与结果和退出密切相关的因素，例如治疗联盟。在任何心理治疗过程中，治疗联盟的破裂（即紧张或崩溃的时期）都不可避免地发生。它们构成提前终止治疗和治疗结果不佳的高风险。治疗师常常无法注意到它们或缺乏建设性地处理它们的技能。尽管联盟破裂的情况屡见不鲜，而且解决失败会带来严重影响，但心理治疗培训课程尚未系统地讨论这一主题。以联盟为中心的培训（AFT）是一种很有前途的方法，可以提高治疗师处理联盟破裂的技能，独立于心理治疗方向，使用治疗课程的视频记录和角色扮演作为核心要素。之前的研究，包括自己的试点研究（由海格尔基金会资助），强调了该方法的潜力。然而，缺乏大规模试验的证据。该项目旨在通过一项随机对照多中心试验，按合作中心（n=11个心理治疗培训机构）、治疗方法（CBT）分层，调查AFT（与通常的心理治疗培训，TAU）对抑郁症患者（计划n = 232）及其见习治疗师（认知行为，CBT或心理动力学心理治疗，PDT；计划n = 116）的有效性 vs. PDT），以及共病人格障碍。治疗疗程（50 分钟）每周进行一次，后评估将在 20 周后进行，第一次随访将在 35 周后进行。两个按层次排列的主要假设是：与 TAU 相比，在 AFT 中，预计 20 周后自评抑郁症状（第一个主要终点）的减少幅度更大，患者退出率（第二个主要终点）更低。次要结果参数是：自评抑郁症状和退出、观察者评价抑郁症状的其他测量点；自评焦虑、躯体主诉、人格结构和人际关系问题、患者的生活质量，以及治疗师的治疗能力和对监督的更高满意度。此外，将以证据为基础的调解员将受到调查。拟议项目重点关注最常见的疾病之一，致力于与日常实践高度相关的主题，并采用随机对照多中心设计，包括德国各地的 11 个培训机构。因此，这些结果具有巨大的潜力，可以为基于证据的心理治疗培训和改善抑郁症患者的治疗结果做出重大贡献。