Therapist competence in cognitive therapy for depression: predicting subsequent symptom change.
Therapist competence in cognitive therapy for depression: predicting subsequent symptom change.
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DOI：
10.1037/a0019631
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发表时间：
2010-06
影响因子：
5.9
通讯作者：
Hollon, Steven D.
中科院分区：
文献类型：
--
作者：
Strunk, Daniel R.;Brotman, Melissa A.;DeRubeis, Robert J.;Hollon, Steven D.
认知疗法（CT）对抑郁症的疗效已得到证实。衡量治疗师提供治疗是否充分的措施对于促进治疗师培训和治疗传播至关重要。虽然一些研究发现 CT 能力与结果之间存在关联，但研究尚未解决能力评级是否可以预测后续结果的问题。在一项临床试验中，我们以 60 名中度至重度抑郁症门诊患者为样本，检查了能力评级（使用认知治疗量表）作为随后症状变化的预测指标。能力评级可预测治疗早期各个疗程的症状变化。在专注于预测 4 次早期治疗后直至 16 周治疗结束时症状变化的分析中，能力是评估者评估的治疗结束时抑郁症状严重程度的重要预测因素，并且可以预测自我报告的非显着趋势水平的症状严重程度。为了调查能力对于具有特定复杂特征的客户是否更重要，我们检查了四种患者特征作为能力与结果关系的潜在调节因素。与没有这些特征的患者相比，对于焦虑程度较高、发病年龄较早的患者以及（在趋势水平上）患有慢性抑郁症（慢性抑郁症或心境恶劣）的患者，能力与后续结果的相关性更高。能力评级并不能更好地预测符合（与不符合）人格障碍标准的患者（即临床试验中代表的人格障碍患者）的后续结果。这些发现为 CT 能力评级在应用环境中的潜在效用提供了支持。
The efficacy of cognitive therapy (CT) for depression has been well-established. Measures of the adequacy of therapists’ delivery of treatment are critical to facilitating therapist training and treatment dissemination. While some studies have found an association between CT competence and outcome, research has yet to address whether competence ratings predict subsequent outcomes. In a sample of 60 moderate to severely depressed outpatients from a clinical trial, we examined competence ratings (using the Cognitive Therapy Scale) as a predictor of subsequent symptom change. Competence ratings predicted session-to-session symptom change early in treatment. In analyses focused on predicting symptom change following four early sessions through the end of 16 weeks of treatment, competence was a significant predictor of evaluator-rated end of treatment depressive symptom severity, and was predictive of self-reported symptom severity at the level of a non-significant trend. To investigate whether competence is more important to clients with specific complicating features, we examined four patient characteristics as potential moderators of the competence-outcome relation. Compared to patients without these characteristics, competence was more highly related to subsequent outcome for patients with higher anxiety, an earlier age of onset, and (at a trend level) patients with a chronic form of depression (chronic depression or dysthymia). Competence ratings were not more predictive of subsequent outcomes among patients who met (vs. did not meet) criteria for a personality disorder (i.e., among personality disorders represented in the clinical trial). These findings provide support for the potential utility of CT competence ratings in applied settings.
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影响因子：
3.7
作者：
Gibbons, Carly J.;DeRubeis, Robert J.
通讯作者：
DeRubeis, Robert J.
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DeRubeis, RJ;Hollon, SD;Gallop, R
通讯作者：
Gallop, R
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作者：
Kuyken, Willem;Tsivrikos, Dimitrios
通讯作者：
Tsivrikos, Dimitrios
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Trepka, C;Rees, A;Barkham, M
通讯作者：
Barkham, M
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作者：
Fournier, Jay C.;DeRubeis, Robert J.;Hollon, Steven D.
通讯作者：
Hollon, Steven D.