Abstract

Objective:

This study explored whether treatment outcomes in a trial on the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) vs. Supportive Psychotherapy (SP) for patients with early-onset chronic depression differ between alliance patterns.

Method:

Session-to-session ratings of the therapeutic alliance (Helping Alliance Questionnaire (HAQ)) from 254 outpatients with chronic depression (CBASP: 134; SP: 120) who took part in a multicenter randomized controlled trial of CBASP vs. SP were used to categorize patients into three alliance pattern categories for the patients’ and therapists’ rating separately. Based on the reliable change in the HAQ from one session to the next categories were: no rupture, unrepaired rupture, rupture-repair. Depression severity (24-item Hamilton Rating Scale for Depression) at post-treatment, at 12- and 24- months follow-up was the outcome.

Results:

The alliance pattern categories for therapists and patients did not differ between CBASP and SP. Only the alliance patterns calculated for patients were associated with outcome: in the unrepaired rupture category, patients had higher HRSD-ratings across time points (p = 0.047).

Conclusions:

CBASP was not associated with more or fewer ruptures or repairs as compared to SP in the treatment of chronic depression. The study highlights the need to resolve ruptures to avoid poor outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT00970437.

中文翻译：

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联盟破裂和修复对结果的影响

摘要

客观的：

本研究探讨了针对早发性慢性抑郁症患者的心理治疗认知行为分析系统 (CBASP) 与支持性心理治疗 (SP) 试验中的治疗结果是否因联盟模式而异。

方法：

来自参加 CBASP 与 SP 的多中心随机对照试验的 254 名慢性抑郁症门诊患者（CBASP：134；SP：120）的治疗联盟（Helping Alliance Questionnaire (HAQ)）的逐期评级用于将患者分为三个联盟模式类别，分别用于患者和治疗师的评级。基于从一个会话到下一个类别的 HAQ 的可靠变化是：无破裂、未修复破裂、破裂修复。结果是治疗后、12 个月和 24 个月随访时的抑郁严重程度（24 项汉密尔顿抑郁量表）。

结果：

CBASP 和 SP 之间的治疗师和患者的联盟模式类别没有差异。只有为患者计算的联盟模式与结果相关：在未修复的破裂类别中，患者跨时间点的 HRSD 评分较高 ( p  = 0.047)。

结论：

在慢性抑郁症的治疗中，与 SP 相比，CBASP 与更多或更少的破裂或修复无关。该研究强调需要解决破裂以避免不良结果。

试用注册： ClinicalTrials.gov 标识符：NCT00970437。