Estudo de associação entre aliança terapêutica e sintomas ansiosos, depressivos e de irritabilidade através de tele-psicoterapias no contexto da pandemia de covid-19.
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Data
2023-03
Autores
Orientador
Shansis, Flávio Milman
Banca
Eizirik, Cláudio Laks
Heidrich, Daiane
Silva, Guilherme Liberato Da
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Resumo
As tele-psicoterapias por videoconferência, como a tele-psicoterapia cognitivo-comportamental (tele-TCC) e a tele-psicoterapia interpessoal (tele-TIP), estão sendo cada vez mais utilizadas para tratar pessoas com ansiedade, depressão e irritabilidade. Embora a eficácia desses tratamentos tenha evidências que estão progressivamente sendo demonstradas, outros fatores associados aos seus resultados ainda precisam ser melhor explorados. A aliança terapêutica (AT) refere-se aos aspectos colaborativos da relação terapeuta-paciente e é um importante fator associado aos resultados em psicoterapias presenciais; até o momento, contudo, existem poucos estudos abordando especificamente a AT em tele-psicoterapia. Os objetivos deste estudo são entender: (a) Quão forte é a TA em tele-TCC e tele-TIP; (b) Se existe alguma diferença nos níveis de AT entre tele-TCC e tele-TIP e (c) Se existe uma correlação entre AT e resultados clínicos de tele-TCC e tele-TIP. No presente estudo, foi realizada uma análise secundária por protocolo a partir de um ensaio clínico randomizado (ECR), realizado pelo nosso grupo, formado por dois braços paralelos comparando tele-TCC e tele-TIP. As principais medidas de desfecho foram o PHQ-9 para sintomas depressivos, GAD-7 para sintomas de ansiedade e ARI para irritabilidade. Os níveis de AT foram medidos utilizando o Working Alliance Inventory - versão curta para pacientes (WAI-s). A correlação dos resultados com a AT foi analisada através do coeficiente de correlação de Pearson. Sessenta e nove indivíduos (tele-TCC n=30; tele-TIP n=39) foram incluídos. A pontuação total do WAI-s na amostra de tele-TCC foi de 74,5 (± 8,3) e na amostra de tele-TIP foi de 76,3 (± 7,4); portanto, ao se comparar os níveis de TA entre tele-TCC e tele-TIP, não houve diferença estatisticamente significativa (p=0.852). Foi encontrada uma correlação significativa entre os níveis de AT e a redução da ansiedade na amostra completa (p=0.032) . Por outro lado, não foi encontrada correlação entre os níveis de AT e níveis de ansiedade quando as amostras foram analisadas separadamente (t-CBT p=0.311; t-IPT p-0.063), assim como não houve correlação entre os níveis de AT e níveis de depressão ou irritabilidade (p>0.05). O presente estudo conclui que níveis elevados de TA são formados entre paciente e terapeuta tanto no t-CBT quanto no t-IPT, sem diferença estatisticamente significativa entre estas duas modalidades de tele-psicoterapia. Ainda, os resultados deste estudo demonstram que a AT esteve associada à redução nos níveis de ansiedade, mas não houve associação entre os níveis de AT e os desfechos depressão ou irritabilidade.
Tele psychotherapies via videoconference, such as tele-Cognitive Behavioral Psychotherapy (t-CBT) and tele-Interpersonal Psychotherapy (t-IPT) are increasingly being used to treat people with anxiety, depression and irritability. Although the effectiveness of these treatments has evidence that is progressively being demonstrated, other factors associated with their results still need to be better explored. Therapeutic alliance (TA) refers to the collaborative aspects of the therapist-patient relationship and is an important factor associated with outcomes in in-person psychotherapies; to date, however, there are few studies specifically addressing TA in tele-psychotherapy. The aims of this study are to address: (a) How strong is TA in t-CBT and t-IPT; (b) Whether there is a difference in TA levels between t-CBT and t-IPT; (c) Whether there is a correlation between TA and clinical outcomes of t-CBT and t-IPT. In the present study, a secondary analysis per protocol was performed based on a randomized clinical trial (RCT), carried out by our group, formed by two parallel arms comparing t-CBT and t-IPT. The main outcome measures were PHQ-9 for depressive symptoms, GAD-7 for anxiety symptoms and ARI for irritability. TA levels were measured using Working Alliance Inventory- short version for patients (WAI-s). The correlation of main outcomes with TA was analyzed using Pearson's correlation coefficient. Sixty-nine subjects (t-CBT n=30; t-IPT n=39) were included. The total WAI-s score in the t-CBT sample was 74.5 (± 8.3) and in the t-IPT sample was 76.3 (± 7.4), therefore, when comparing the levels of TA between tele-TCC and tele-TIP, there was no significant difference (p=0.852). A significant correlation was found between TA levels and anxiety reduction in the complete sample (p=0.032). On the other hand, no correlation was found between TA levels and anxiety levels when the samples were analyzed separately (t-CBT p=0.311; t-IPT p-0.063), as well as no correlation between TA levels and levels of depression or irritability (p>0.05). The present study concludes that high levels of TA are formed between patient and therapist both in t-CBT and in t-IPT, with no statistically significant difference between them. Furthermore, the results of this study demonstrate that TA was associated with a reduction in anxiety levels, but there was no association between TA levels and depression or irritability outcomes.
Tele psychotherapies via videoconference, such as tele-Cognitive Behavioral Psychotherapy (t-CBT) and tele-Interpersonal Psychotherapy (t-IPT) are increasingly being used to treat people with anxiety, depression and irritability. Although the effectiveness of these treatments has evidence that is progressively being demonstrated, other factors associated with their results still need to be better explored. Therapeutic alliance (TA) refers to the collaborative aspects of the therapist-patient relationship and is an important factor associated with outcomes in in-person psychotherapies; to date, however, there are few studies specifically addressing TA in tele-psychotherapy. The aims of this study are to address: (a) How strong is TA in t-CBT and t-IPT; (b) Whether there is a difference in TA levels between t-CBT and t-IPT; (c) Whether there is a correlation between TA and clinical outcomes of t-CBT and t-IPT. In the present study, a secondary analysis per protocol was performed based on a randomized clinical trial (RCT), carried out by our group, formed by two parallel arms comparing t-CBT and t-IPT. The main outcome measures were PHQ-9 for depressive symptoms, GAD-7 for anxiety symptoms and ARI for irritability. TA levels were measured using Working Alliance Inventory- short version for patients (WAI-s). The correlation of main outcomes with TA was analyzed using Pearson's correlation coefficient. Sixty-nine subjects (t-CBT n=30; t-IPT n=39) were included. The total WAI-s score in the t-CBT sample was 74.5 (± 8.3) and in the t-IPT sample was 76.3 (± 7.4), therefore, when comparing the levels of TA between tele-TCC and tele-TIP, there was no significant difference (p=0.852). A significant correlation was found between TA levels and anxiety reduction in the complete sample (p=0.032). On the other hand, no correlation was found between TA levels and anxiety levels when the samples were analyzed separately (t-CBT p=0.311; t-IPT p-0.063), as well as no correlation between TA levels and levels of depression or irritability (p>0.05). The present study concludes that high levels of TA are formed between patient and therapist both in t-CBT and in t-IPT, with no statistically significant difference between them. Furthermore, the results of this study demonstrate that TA was associated with a reduction in anxiety levels, but there was no association between TA levels and depression or irritability outcomes.
Descrição
Palavras-chave
Aliança terapêutica; Ansiedade; Depressão; Ensaio clínico randomizado; Pesquisa em psicoterapia; Psicoterapia; Tratamento via Internet; Anxiety; Depression; Internet-based treatment; Psychotherapy; Psychotherapy research; Randomized clinical trial; Therapeutic Alliance
Citação
LUCAS, Luiza Silveira. Estudo de associação entre aliança terapêutica e sintomas ansiosos, depressivos e de irritabilidade através de tele-psicoterapias no contexto da pandemia de covid-19.. 2023. Dissertação (Mestrado) – Curso de Ciências Médicas, Universidade do Vale do Taquari - Univates, Lajeado, 24 mar. 2023. Disponível em: http://hdl.handle.net/10737/3684.