Working alliance in exposure-based treatments of posttraumatic stress disorder related to childhood abuse.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2024-07-01 DOI:10.1037/ccp0000899

Danielle A C Oprel, Chris M Hoeboer, Maartje Schoorl, Rianne A de Kleine, Willem van der Does, Agnes van Minnen

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Abstract

Objectives: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout.

Method: Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models.

Results: Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout.

Conclusion: In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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与童年受虐有关的创伤后应激障碍暴露疗法中的工作联盟。

目的：工作联盟被认为是心理治疗结果的重要决定因素。童年受虐后创伤后应激障碍（PTSD）患者在建立人际关系（包括工作联盟）方面可能面临挑战。分阶段治疗提供了一个在以创伤为重点的治疗之前加强联盟的机会。本研究旨在比较三种延长暴露疗法（PE）中 CA-PTSD 患者工作联盟的发展情况：标准 PE、强化 PE（iPE）以及情感和人际关系调节技能训练 + 延长暴露疗法（STAIR + PE）。我们还研究了联盟对治疗结果和辍学的影响：在一项临床试验中，我们评估了自我报告的《精神疾病诊断与统计手册》第五版创伤后应激障碍核对表（Blevins 等人，2015 年）和患者评分的工作联盟量表（Tracey & Kokotovic，1989 年）。我们分析了 138 名成年患者（76.1% 为女性；42% 为非西方人）的数据。分析采用混合效应模型进行：结果：患者在治疗初期建立了令人满意的联盟关系，随着时间的推移，这种关系不断加强。在 PE 和 STAIR + PE 治疗中，创伤后应激障碍症状严重程度的大幅下降与随后治疗中更高的联盟度有关，但与此相反。在 STAIR + PE 中，第一阶段较高的联盟度与第二阶段较低的创伤后应激障碍症状有关。在所有情况下，较高的初始工作联盟与较低的治疗退出几率有关：结论：在CA-创伤后应激障碍的治疗中，延长暴露的三种变体都能促进工作联盟的积极发展。在各种条件下，工作联盟并不先于症状的减轻。治疗师应在治疗开始时努力建立牢固的联盟，因为这可以降低辍学的可能性。(PsycInfo Database Record (c) 2024 APA，保留所有权利）。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.