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The Alliance-Outcome Association in the Treatment of Adolescent Depression

机译：联盟 - 结局协会治疗青少年抑郁症

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A growing body of research has consistently demonstrated a relationship between alliance and treatment outcomes in youth psychotherapy. However, previous research often suffered methodological issues that prevented detailed investigation of temporal relationships between alliance and symptomatology. The current study explored the directions of effect between alliance and outcome by examining the associations between early alliance and subsequent outcome while controlling for patients' baseline severity and prior symptom change. It also examined potential moderators of this association. Data were drawn from the IMPACT study, a randomized controlled trial comparing cognitive-behavioral therapy and short-term psychoanalytic psychotherapy versus a brief psychosocial intervention in the treatment of adolescent depression. Adolescents (N = 224) and therapist (n = 139) rated the alliance 6 weeks after randomization. Depression severity and overall psychopathology were assessed at baseline, 6, 12, 36, 52, and 86 weeks after randomization. Patients' age, gender, baseline depression severity, conduct disorder symptoms, and treatment type were examined as potential moderators of the alliance-outcome association. Data were analyzed using multilevel models. Findings suggested that higher early alliance ratings were associated with subsequent symptom reduction, even after controlling for prior symptom change and baseline severity. There was some evidence that the strength of this association was strongest in cognitive-behavioral therapy, weaker in short-term psychoanalytic psychotherapy, and statistically indistinguishable from zero in brief psychosocial intervention. These findings suggest that early therapeutic alliance with adolescents may influence subsequent outcome independent of prior symptom change and initial severity but that the effect of the alliance on outcome might vary across treatment types.
机译：越来越多的研究一致表明，青年心理治疗中的联盟与治疗结果之间存在关系。然而，以前的研究经常遇到方法学问题，无法详细调查联盟和症状学之间的时间关系。目前的研究通过检查早期联盟与后续结果之间的关联，同时控制患者的基线严重程度和先前症状变化，探索联盟与结果之间的影响方向。它还审查了该协会的潜在主持人。数据来自IMPACT研究，这是一项随机对照试验，比较了认知行为疗法和短期精神分析心理疗法与短期心理社会干预在青少年抑郁症治疗中的作用。随机分组6周后，青少年（N=224）和治疗师（N=139）对联盟进行了评分。在随机分组后的基线、6周、12周、36周、52周和86周评估抑郁严重程度和整体精神病理学。患者的年龄、性别、基线抑郁严重程度、品行障碍症状和治疗类型被视为联盟结果关联的潜在调节因素。数据分析采用多水平模型。研究结果表明，更高的早期联盟评分与随后的症状减轻相关，即使在控制了之前的症状变化和基线严重程度之后也是如此。有证据表明，这种联系在认知行为治疗中最强，在短期精神分析心理治疗中较弱，在短期心理社会干预中从统计学上看与零没有区别。这些发现表明，与青少年的早期治疗联盟可能独立于先前的症状变化和初始严重程度而影响后续结果，但联盟对结果的影响可能因治疗类型而异。

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