Abstract

A patient's ambivalence toward medical and psychotherapeutic treatment is a strong predictor of its outcome. This is especially relevant in the treatment of common chronic conditions such as hypertension (HT), in which most patients do not maintain the lifestyle changes that lie at the heart of the medical treatment. Despite the growing theoretical interest, there is little empirical research on how patients deal with and resolve their ambivalence, and almost all of the studies focus on psychotherapy clients, not on chronic illness patients. This study aims to understand how patients with AHT deal with their ambivalence toward their medical treatment, using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to identify their anti and pro adherence “voices” and the different strategies patients use for dealing with their ambivalence. Results describe integration strategies, which allow both opposing voices to express themselves and be heard, and domination strategies which reject or dismiss one of the voices. The temporal dynamics between PRO and ANTI adherence voices during the interviews are also explored. These results are discussed to contribute to the research on ambivalence and support concrete guidelines for dealing with patient nonadherence.

摘要

患者对医学和心理治疗的矛盾心理是其结果的一个强有力的预测因素。这在治疗高血压 (HT) 等常见慢性病时尤其重要，在高血压 (HT) 中，大多数患者无法保持作为医疗核心的生活方式改变。尽管对理论的兴趣日益浓厚，但关于患者如何处理和解决他们的矛盾心理的实证研究却很少，几乎所有的研究都集中在心理治疗的客户身上，而不是针对慢性病患者。本研究旨在使用对话式自我理论和定性研究方法，了解 AHT 患者如何处理他们对医疗的矛盾心理。我们采访了 51 名高血压患者，以确定他们反对和支持依从性的“声音”以及患者用于处理矛盾心理的不同策略。结果描述整合策略，允许两个对立的声音表达自己和被听到，以及拒绝或拒绝其中一个声音的支配策略。还探讨了访谈期间 PRO 和 ANTI 依从性声音之间的时间动态。讨论这些结果有助于对矛盾心理的研究，并支持处理患者不依从性的具体指南。