Which Mechanism Kicks in When? Temporal Changes in the Effect of Transtheoretical Factors on Symptom Distress Over the Course of Therapy.

IF 1.9 3区 医学 Q3 PSYCHIATRY
Psychopathology Pub Date : 2025-07-02 DOI:10.1159/000546285
Brian Schwartz, Danilo Moggia, Jay Lawrynowicz, Julian A Rubel, Wolfgang Lutz
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引用次数: 0

Abstract

Introduction: The mechanisms of change in psychological therapies have not yet been sufficiently empirically validated. In particular, the time course of their effects on patients' symptom distress is unknown. Therefore, the aims of the present study were (1) to examine the effects of four patient experiences, namely interpersonal (IE), coping (CE), affective (AE), and resource-related experiences (RE), on symptom distress within and between patients, (2) to consider the temporal development of the within-patient effects, and (3) to examine their associations with the final treatment outcome.

Methods: Within- and between-patient effects of IE, CE, AE, and RE on session-level symptom distress were calculated for n = 2208 outpatients treated by n = 253 therapists. Patient experiences were measured after each session using session reports, outcome was assessed with the HSCL-11 at the beginning of each session and with the OQ-30 after treatment. Linear mixed models (LMMs) were used to examine the within- and between-patient associations. Temporal changes in the within-patient effects were modelled using rolling windows and three-level LMMs (sessions nested in windows and patients).

Results: Within-patient components of all four patient experiences were significantly associated with symptom distress (b = -0.006 to b = -0.057), while none of the between-patient components were. The effects of all four patient experiences diminished over time (b = 0.000 to b = 0.001). The effects of IE, CE, and RE remained negative and significant, but the effect of AE crossed zero and became significantly positive with an increasing window number. A greater decrease in the within-patient effects of IE (b = -0.001) and CE (b = -0.001) on HSCL-11 was associated with better final treatment outcomes.

Conclusion: The results suggest that all four change factors are drivers of successful therapy, particularly in the early sessions. Over the course of treatment their impact on symptom distress diminishes, which appears to be beneficial for the final treatment outcome. In the future, differences between patients in the temporal dynamics of change factors should be investigated to inform transtheoretical and process-based treatments that support therapists in personalizing their treatments to individual patients.

哪种机制何时起作用?治疗过程中跨理论因素对症状困扰影响的时间变化。
引言:心理治疗变化的机制尚未得到充分的经验验证。特别是,它们对患者症状困扰的影响的时间过程是未知的。因此,本研究的目的是:(1)研究四种患者体验,即人际体验(IE)、应对体验(CE)、情感体验(AE)和资源相关体验(RE)对患者内部和患者之间症状困扰的影响,(2)考虑患者内部效应的时间发展,(3)研究它们与最终治疗结果的关联。方法:对n = 253名治疗师治疗的2208例门诊患者计算IE、CE、AE和RE对疗程水平症状困扰的患者内和患者间影响。在每次治疗后使用治疗报告测量患者体验,在每次治疗开始时使用hsl -11和治疗后使用OQ-30评估结果。线性混合模型(lmm)用于检查患者内部和患者之间的关联。患者内效应的时间变化使用滚动窗口和三级lmm(嵌套在窗口和患者中的会话)进行建模。结果:所有四种患者经历的患者内部成分与症状困扰显著相关(b = -0.006至b = -0.057),而患者之间成分则没有。所有四种患者经历的影响随着时间的推移而减弱(b = 0.000至b = 0.001)。IE、CE和RE的影响仍然为负且显著,但AE的影响越过零并随着窗口数的增加而变为显著的正影响。IE (b = -0.001)和CE (b = -0.001)对hsl -11的患者内效应的更大降低与更好的最终治疗结果相关。结论:结果表明,所有四个改变因素是成功治疗的驱动因素,特别是在早期阶段。在治疗过程中,它们对症状困扰的影响减弱,这似乎有利于最终的治疗结果。在未来,应该研究患者在变化因素的时间动态方面的差异,为跨理论和基于过程的治疗提供信息,以支持治疗师针对个体患者进行个性化治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Psychopathology
Psychopathology 医学-精神病学
CiteScore
5.10
自引率
5.60%
发文量
54
审稿时长
>12 weeks
期刊介绍: ''Psychopathology'' is a record of research centered on findings, concepts, and diagnostic categories of phenomenological, experimental and clinical psychopathology. Studies published are designed to improve and deepen the knowledge and understanding of the pathogenesis and nature of psychopathological symptoms and psychological dysfunctions. Furthermore, the validity of concepts applied in the neurosciences of mental functions are evaluated in order to closely bring together the mind and the brain. Major topics of the journal are trajectories between biological processes and psychological dysfunction that can help us better understand a subject’s inner experiences and interpersonal behavior. Descriptive psychopathology, experimental psychopathology and neuropsychology, developmental psychopathology, transcultural psychiatry as well as philosophy-based phenomenology contribute to this field.
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