Background and objectives

This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome.

Methods

One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects.

Results

We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up.

Limitations

The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment.

Conclusions

Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression.

中文翻译：

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不一致的负面自我关联是门诊心理治疗后抑郁恶化的危险因素。

背景和目标

本文研究了抑郁症认知心理治疗后内隐和外显消极自我关联 (NSA) 之间的差异，作为长期结果的预测指标。

方法

在限时门诊抑郁心理治疗结束时，120 名患者完成了将自我与抑郁属性相关联的内隐联想测试和具有相同项目内容的自我报告问卷。在治疗后和 3、6 和 12 个月的随访中，患者完成了 BDI-II。我们使用不同的策略来操作隐式和显式 NSA 差异和三级分层线性模型来分析影响。

结果

我们发现隐性和显性 NSA 之间的差异以及差异的方向对长期结果的显着交互影响。在显性比隐性 NSA（受损的自尊模式）更大的患者中，更大的绝对差异与随访结束时 BDI 评分和随访期间变化率更差的长期结果相关。一致地，通过另一种方法，我们发现受损的自尊差异与随访结束时估计的 BDI-II 评分较差有关。

限制

样本中仅包含治疗完成者限制了结果的普遍性。此外，随访期仅记录了治疗后的前 12 个月。

结论

我们的结果支持这样一种观点，即内隐和外显的负面自我关联之间的差异可能是抑郁症心理治疗后恶化的危险因素。