OBJECTIVE This study explores in cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) to what degree therapists' perceptions of their patients as interpersonally challenging (IC) is explained by the therapist or patient effects, if baseline patients' characteristics predict IC, and if IC is related to outcome. METHOD Eighty patients diagnosed with GAD and treated by 20 therapists with 16 sessions of CBT were randomized to two different implementation conditions. Patients completed baseline measures of depression, anxiety, interpersonal problems, and interpersonal strengths. The therapists completed a single-item assessing IC session-by-session. As an outcome, patients completed a worry measure at baseline, session 5, session 10, and posttreatment. RESULTS Multilevel models showed meaningful therapist effects, explaining 18% of IC variance. Interpersonal strengths were the only baseline predictor significantly and negatively associated with IC during treatment. Structural equation models showed significant negative IC effects on subsequent patient worry during therapy. CONCLUSIONS IC might represent a risk factor for psychotherapy outcome. Patient interpersonal strengths at baseline may buffer therapists perceiving their patients as ICs. The therapist effects on IC suggest that CBT clinicians treating GAD might benefit from identifying cases that are interpersonally challenging for them and reflecting about what might trigger that perception.

中文翻译：

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治疗师对广泛性焦虑症患者人际关系挑战的看法。

目的 本研究探讨在广泛性焦虑症 (GAD) 的认知行为疗法 (CBT) 中，如果基线患者的特征预测 IC，治疗师对患者的人际关系挑战 (IC) 的看法在多大程度上可以由治疗师或患者的影响来解释, 以及 IC 是否与结果相关。方法 80 名诊断为广泛性焦虑症并接受 20 名治疗师 16 次 CBT 治疗的患者被随机分配到两种不同的实施条件下。患者完成了抑郁、焦虑、人际关系问题和人际关系优势的基线测量。治疗师逐个会话完成单项评估 IC。结果，患者在基线、第 5 次、第 10 次和治疗后完成了忧虑测量。结果 多层次模型显示出有意义的治疗效果，解释了 18% 的 IC 方差。人际关系优势是治疗期间与 IC 显着负相关的唯一基线预测因子。结构方程模型显示出显着的负面 IC 对后续患者在治疗期间的担忧产生影响。结论 IC 可能是心理治疗结果的一个危险因素。基线时患者的人际关系优势可能会缓冲治疗师将患者视为 IC。治疗师对 IC 的影响表明，治疗 GAD 的 CBT 临床医生可能会受益于识别对他们来说具有人际关系挑战的案例，并反思可能引发这种看法的因素。结构方程模型显示出显着的负面 IC 对后续患者在治疗期间的担忧产生影响。结论 IC 可能是心理治疗结果的一个危险因素。基线时患者的人际关系优势可能会缓冲治疗师将患者视为 IC。治疗师对 IC 的影响表明，治疗 GAD 的 CBT 临床医生可能会受益于识别对他们来说具有人际关系挑战的案例，并反思可能引发这种看法的因素。结构方程模型显示出显着的负面 IC 对后续患者在治疗期间的担忧产生影响。结论 IC 可能是心理治疗结果的一个危险因素。基线时患者的人际关系优势可能会缓冲治疗师将患者视为 IC。治疗师对 IC 的影响表明，治疗 GAD 的 CBT 临床医生可能会受益于识别对他们来说具有人际关系挑战的案例，并反思可能引发这种看法的因素。