Open Door Review III

@)&0%2()%6!):!7#2*D0!$*!1647#)2*2<4($7_!1647#)&4*29$7_!2*&! 7)D*$($Y0E30#2Y$)%2

HB30%_!O>_!H0*%$7#_!S>!G!I![+,-P^>!@)&0%2()%6!):!7#2*D0!$*!1647#)2*2<4($7_!1647#)&4*29$7_!2*&! 7)D*$($Y0E30#2Y$)%2! N">#+@B&"!&,-%&/$%#)?@+&'(A?-"@+@BA,)?&/(("?)@,)"+O&gI _!.b.E.b\>!!! >-001(3 ! The present study focuses on the examination of moderators of change during psychotherapy. Outcome research in psychotherapy has proceeded remarkably, and that the effects of psychotherapy are statistically and clinically significant is empirically well founded. But “much more research needs to be conducted before the exact relationship between the process of the therapy and its outcome will be known” (Lambert and Ogles 2004). For that reason, the focus of psychotherapy research has shifted from investigating outcome to a process-outcome approach. A moderator is “a characteristic that influences the direction or magnitude of the relationship between an independent and a dependent variable” (Kazdin 2007). Moderators precede treatment and are not correlated with it. Identifying them helps in the prognosis of a course of therapy and in matching different patients to treatments. The empirical basis of the process-outcome study is the Munich Psychotherapy Study (MPS), a prospective, comparative process-outcome study that evaluates the effectiveness and course of three different long-term psychotherapies: psychoanalytic (PA), psychodynamic (PD), and cognitive- behavioral (CBT) for a diagnostically homogenous sample of depressed patients. Patients seeking treatment for unipolar depression, single-episode or recurrent, and meeting the inclusion criterion were asked to participate in the study. The inclusion criterion was a primary diagnosis of a moderate or severe episode of major depressive disorder (ICD-10 F 32.1/2 or DSM-IV 296.22/23); a recurrent depressive disorder, current episode moderate or severe, without psychotic symptoms (ICD-10 F 33.1/2 or DSM-IV 296.32/33); or a double depression. Thirty-five patients were assigned to PA, 31 to PD, and 34 to CBT. Psychoanalytic therapy (PA) was operationalized as a therapy with a session frequency of three times a week, with the patient lying on the couch. Psychodynamic therapy (PD) was operationalized as a therapy with one session a week, in a face-to-face setting. Cognitive - behavioral therapy (CBT) was operationalized as a therapy with one session a week. For this study, the outcome measure battery included the Beck Depression Inventory (BDI) on a symptomatic level, the Inventory of Interpersonal Problems (IIP) on an interpersonal level, and the Scales of Psychological Capacities (SPC) on an intrapsychic level. Outcome measurement points were pre-treatment and post-treatment. The following independent variables considered as putative moderators were assessed at pre-treatment: age, sex, partnership status, duration of depressive disorder since onset, and prior therapies, as well as observer-rated motivation for therapy and diagnosis of personality disorder during a clinical intake interview. Also included were the patient-rated Emotional Lability and Extroversion scale of the Freiburg Personality Inventory (FPI) and the therapist-rated subscale HAQ2: satisfaction with therapeutic relationship of the Helping Alliance Questionnaire (HAQ). To show that the independent variables listed above are moderators of treatment effects, they were entered into a stepwise logistic regression analysis. Treatment modality (PA, PD, CBT) was included as the first step. The analysis was repeated with the dependent variables BDI, IIP, and SPC. The treatment effect was assessed as “clinical significance”. The results are presented as odds ratios (ORs). Stepwise logistic regression analysis yielded that the Emotional Lability scale of the FPI (OR = 1.47) and diagnosis of a personality disorder (OR = 3.82) both negatively predicted outcome in the BDI. Partnership status (OR = 3.52), therapy dose (OR = 1.02) and satisfaction with therapeutic relationship (OR = 3.84) predicted positive outcome when

PNK

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