A central tenet of psychodynamic theory of depression is the role of avoided anger. However empirical research has not yet addressed the question of for which patients and via what pathways experiencing anger in sessions can help. The therapeutic alliance and acquisition of patient insight are important change processes in dynamic therapy and may mediate the anger-depression association. This study was embedded into a randomized trial testing the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression. In-session patient affect experiencing (AE) was coded for every available session (475/481) by blinded observers in 27 patients randomized to ISTDP. Dynamic Structural Equation Modeling was used to examine within-person associations between variation in depression scores session-by-session and both patient ratings (alliance) and observer ratings (AE and insight) of the treatment process. Alliance and insight were independent mediators of the effect of anger on next-session depression. However, the relative importance of these two indirect effects of anger on depression was conditional on pretreatment patient personality pathology (PP). In patients with higher PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through higher alliance. In patients with low PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through enhanced patient insight. These findings highlight an anger-depression mechanism of change in dynamic therapy. Depending upon patient personality, either an "insight pathway" or a "relational pathway" may promote the effectiveness of facilitating arousal and expression of patients' in-session feelings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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动态治疗中的愤怒 - 抑郁机制：体验先前避免的愤怒积极预测通过工作联盟和洞察力减少抑郁症。

抑郁心理动力学理论的一个中心原则是避免愤怒的作用。然而，实证研究尚未解决以下问题：哪些患者以及通过哪些途径在治疗中经历愤怒可以提供帮助。治疗联盟和患者洞察力的获得是动态治疗中重要的变化过程，可能会调节愤怒-抑郁的关联。这项研究被纳入一项随机试验，测试强化短期动态心理治疗 (ISTDP) 对难治性抑郁症的疗效。在随机分配到 ISTDP 的 27 名患者中，盲人观察员对每个可用会话 (475/481) 对会话中患者情感体验 (AE) 进行编码。动态结构方程模型用于检查抑郁症评分变化与治疗过程的患者评分（联盟）和观察者评分（AE和洞察力）之间的个人关联。联盟和洞察力是愤怒对下一次抑郁症影响的独立中介。然而，愤怒对抑郁的这两种间接影响的相对重要性取决于治疗前患者的人格病理学（PP）。在 PP 较高的患者中，会话中的愤怒与下一次会话的抑郁症状呈负相关，这种影响通过更高的联盟发挥作用。在 PP 较低的患者中，治疗期间的愤怒与下一次治疗的抑郁症状呈负相关，这种影响通过增强患者的洞察力来发挥作用。这些发现突出了动态治疗中变化的愤怒-抑郁机制。根据患者的个性，“洞察途径”或“关系途径”可以提高促进唤醒和表达患者在治疗期间感受的有效性。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。