Abstract

Objective:

The aim of this study was to identify and explore mediators of psychodynamic-interpersonal psychotherapy (PIT) on treatment outcome in multisomatoform disorders (MSD).

Methods:

Data from 164 patients with MSD who took part in a randomized control trial of PIT (n = 88) vs. enhanced medical care (EMC; n = 76) were re-analyzed. A parallel mediation analysis was performed to investigate whether the beneficial effect of PIT vs. EMC on physical quality of life (physical component summary (PCS) of the SF-36 Health Survey) nine months post-treatment is mediated by post-treatment scores of stress, depression, and therapeutic alliance. The potential mediators were operationalized with the Helping Alliance Questionnaire (HAQ; therapeutic alliance), the Patient Health Questionnaire (PHQ)-stress module (perceived stress) and the PHQ-depression module (PHQ-9; depression).

Results:

Stress partially mediated the effect of PIT vs. EMC on the follow-up outcome. PIT (as compared to EMC) led to lower post-treatment stress-levels, which in turn led to higher physical quality of life at follow-up. Neither depression nor the alliance had a mediating effect.

Conclusions:

Stress mediated the outcome of PIT for MSD. Future studies are needed to extend the scope of research regarding which specific psychotherapeutic mechanisms of change are beneficial in PIT treatment of MSD patients.

中文翻译：

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压力、抑郁和治疗联盟作为多躯体形式障碍简短心理动力学-人际心理治疗结果的中介

摘要

客观的：

本研究的目的是确定和探索心理动力学 - 人际心理治疗 (PIT) 对多躯体形式障碍 (MSD) 治疗结果的中介作用。

方法：

重新分析了 164 名参加 PIT ( n  = 88) 与加强医疗护理 (EMC；n  = 76)的随机对照试验的 MSD 患者的数据。进行了平行中介分析以研究 PIT 与 EMC 对治疗后 9 个月身体生活质量（SF-36 健康调查的身体成分总结 (PCS)）的有益影响是否由治疗后评分介导压力、抑郁和治疗联盟。潜在的调解员通过帮助联盟问卷（HAQ；治疗联盟）、患者健康问卷（PHQ）-压力模块（感知压力）和 PHQ-抑郁模块（PHQ-9；抑郁）进行操作。

结果：

压力在一定程度上调节了 PIT 与 EMC 对随访结果的影响。PIT（与 EMC 相比）导致较低的治疗后压力水平，这反过来又导致更高的后续身体生活质量。萧条和联盟都没有中介作用。

结论：

压力介导了 MSD 的 PIT 结果。未来的研究需要扩大研究范围，了解哪些特定的心理治疗变化机制有利于 MSD 患者的 PIT 治疗。