TY - JOUR AU - Bisseling, Else AU - Cillessen, Linda AU - Spinhoven, Philip AU - Schellekens, Melanie AU - Compen, Félix AU - van der Lee, Marije AU - Speckens, Anne PY - 2019 DA - 2019/10/18 TI -治疗联盟的发展及其与痛苦癌症患者基于互联网正能量认知疗法的关联:一项多中心随机对照试验的二次分析JO - J Med Internet Res SP - e14065 VL - 21 IS - 10 KW -治疗联盟KW -远程医疗KW -正念KW -癌症KW -患者退出AB -背景:正念认知疗法(MBCT)是一种基于证据的基于群体的肿瘤心理治疗，可减少抑郁和焦虑症状。基于互联网的MBCT (eMBCT)已被发现是一种有效的替代MBCT。治疗联盟(治疗师和患者之间的纽带)已知对包括MBCT在内的心理治疗结果有重大影响。eMBCT实践中的一个主要问题是能否形成一个良好的治疗联盟。尽管在基于互联网的干预(IBIs)中，治疗师协助对治疗结果的有益作用的证据正在积累，但目前尚不清楚治疗联盟是否与IBIs的结果相关。目的:本研究旨在(1)探讨早期治疗联盟是否预测MBCT或eMBCT的治疗退出，(2)比较eMBCT和MBCT期间治疗联盟的发展，(3)研究早期治疗联盟是否预测两种情况下治疗后心理窘迫的减少和心理健康的增加。方法:本研究是一项多中心随机对照试验(n=245)的一部分，研究MBCT或eMBCT对痛苦癌症患者的有效性。治疗联合在第2周(即早期治疗联合)、第5周和第9周开始时进行测量。结局指标为心理窘迫(用医院焦虑和抑郁量表测量)和心理健康(用心理健康连续简表测量)。 Results: The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t114=−2.656; P=.01) and an increase in mental well-being (B=.23; t113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t113=2.261; P=.03). Conclusions: A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. Trial Registration: ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513 SN - 1438-8871 UR - //www.mybigtv.com/2019/10/e14065 UR - https://doi.org/10.2196/14065 UR - http://www.ncbi.nlm.nih.gov/pubmed/31628791 DO - 10.2196/14065 ID - info:doi/10.2196/14065 ER -