问卷评估在心理干预效果研究中的应用
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摘要
心理干预效果研究中,“恶化”指的是比较两次心理干预的问卷评估结果,存在超过划界分(cutoff)或可信变化指数(RCI)大于规定值的现象。国外已有研究表明,及时发现这种理论上的“恶化”有助于减少实际临床不良心理干预结果的发生。目前国内尚缺少心理干预效果评估的研究,本研究试图探讨在本土实践中,心理问卷评估在心理干预中的作用及其使用的影响因素。
首先,研究一探讨了在个体心理干预过程中,利用问卷评估是否存在当事人心理状况“恶化”的不良结果。研究二探讨了在团体心理干预中,是否同样存在当事人心理状况“恶化”的不良结果。研究三分别探讨了不同专业背景下心理从业人员在使用问卷评估方面是否存在差异。最后,研究四则通过对两例个案的追踪研究,探讨了问卷评估对心理从业人员在实际心理干预中所产生的作用。
本研究结果表明:
(1)采用心理干预效果评估问卷(OQ-45)在当事人个体心理干预期间进行连续评估发现,约5.7%(2/34)的干预个案存在“恶化”状况。
(2)采用心理干预效果评估问卷(OQ-45)在当事人团体心理干预期间进行连续评估发现,约7.7%(3/39)的干预个案存在“恶化”状况。
(3)虚拟情境案例设计研究提示,问卷评估的结果信息对不同背景(年龄、工作经验和教育背景)心理从业人员的干预决策影响存在显著性差异(χ~2 = 19.033,P<0.001;χ~2=16.246,P<0.001;χ~2=7.791,P<0.01),结果提示问卷评估的结果信息对经验越浅、学历越高的新手型心理从业人员的影响较大。
(4)通过对两例个案心理干预的跟踪研究发现,连续问卷OQ-45评估提示,在心理干预中当事人的心理状况变化并非呈线性变化,且当事人在情绪症状、人际关系和社会功能三个维度的改变存在差异。
本研究结果提示,问卷评估有助于对心理干预中的“恶化”状况及时预警,但不同专业背景的心理从业人员对评估结果的使用存在差异,今后应进一步探讨问卷评估对心理干预结果的实际效用。
In psychological intervention effects study,―deteriorate‖referred to compare the results of two psychological intervention questionnaire evaluation, and found it that over the delimitation of points (cutoff) or reliable change index (RCI) than specified value. Foreign studies had shown that, timely found this theoretical "deteriorate" helped to reduce the happening of the result of the actual clinical adverse psychological intervention. At present domestic still lacked of psychological intervention effect evaluation of studies, this study tried to discuss in domestic practice, the effect and its influencing factors of using the psychological questionnaire evaluation in psychological intervention.
First, a research was discussed in an individual's psychological intervention process, using the questionnaire to evaluate whether there were the existences of "psychological condition deteriorates" adverse outcomes. We also discussed whether there were the psychological condition "deteriorate" adverse outcomes in the group psychological intervention. In the research three, we discussed under the background of psychological practitioners in using questionnaire evaluate whether there were differences. Finally, the study of two cases of four through case follow-up study, we discussed the effect of the questionnaire assessment in actual psychological intervention for psychological practitioners.
The research results indicated that:
(1) Using psychological intervention outcome assessment questionnaire (OQ - 45) in the individual psychological intervention during continuous assessment showed that about 5.7% (2/34) intervention cases existing "deteriorate" status.
(2) Using psychological intervention outcome assessment questionnaire (OQ - 45) in the group psychological intervention during continuous assessment showed that about 7.7% (3/39) intervention cases existing "deteriorate" status.
(3) Virtual situation case design research suggested that questionnaire evaluation result of different background information (age, work experience and education background) psychological intervention from personnel of decision-making influence, there were existed significant differences(χ~2 = 19.033,P<0.001;χ~2=16.246,P<0.001;χ~2=7.791,P<0.01). The results indicated that the evaluation result of questionnaire information more shallow, experience the higher degree of novice type psychological practitioners influenced
(4) Through the case study of two cases of psychological intervention study that followed continuous questionnaire assessment hint (OQ–45), psychological intervention in the clients in the psychological situation change was not a linear relation, and the clients in mood symptoms, interpersonal relationship and social function three dimensions changes in different ways.
This research indicated that, questionnaire was helpful for the assessment psychological intervention "deteriorate" situations timely warning, but different professional background of psychological practitioners of evaluation results vary, the future of using questionnaire should be further discussed to assess their psychological intervention results of actual utility.
首先,研究一探讨了在个体心理干预过程中,利用问卷评估是否存在当事人心理状况“恶化”的不良结果。研究二探讨了在团体心理干预中,是否同样存在当事人心理状况“恶化”的不良结果。研究三分别探讨了不同专业背景下心理从业人员在使用问卷评估方面是否存在差异。最后,研究四则通过对两例个案的追踪研究,探讨了问卷评估对心理从业人员在实际心理干预中所产生的作用。
本研究结果表明:
(1)采用心理干预效果评估问卷(OQ-45)在当事人个体心理干预期间进行连续评估发现,约5.7%(2/34)的干预个案存在“恶化”状况。
(2)采用心理干预效果评估问卷(OQ-45)在当事人团体心理干预期间进行连续评估发现,约7.7%(3/39)的干预个案存在“恶化”状况。
(3)虚拟情境案例设计研究提示,问卷评估的结果信息对不同背景(年龄、工作经验和教育背景)心理从业人员的干预决策影响存在显著性差异(χ~2 = 19.033,P<0.001;χ~2=16.246,P<0.001;χ~2=7.791,P<0.01),结果提示问卷评估的结果信息对经验越浅、学历越高的新手型心理从业人员的影响较大。
(4)通过对两例个案心理干预的跟踪研究发现,连续问卷OQ-45评估提示,在心理干预中当事人的心理状况变化并非呈线性变化,且当事人在情绪症状、人际关系和社会功能三个维度的改变存在差异。
本研究结果提示,问卷评估有助于对心理干预中的“恶化”状况及时预警,但不同专业背景的心理从业人员对评估结果的使用存在差异,今后应进一步探讨问卷评估对心理干预结果的实际效用。
In psychological intervention effects study,―deteriorate‖referred to compare the results of two psychological intervention questionnaire evaluation, and found it that over the delimitation of points (cutoff) or reliable change index (RCI) than specified value. Foreign studies had shown that, timely found this theoretical "deteriorate" helped to reduce the happening of the result of the actual clinical adverse psychological intervention. At present domestic still lacked of psychological intervention effect evaluation of studies, this study tried to discuss in domestic practice, the effect and its influencing factors of using the psychological questionnaire evaluation in psychological intervention.
First, a research was discussed in an individual's psychological intervention process, using the questionnaire to evaluate whether there were the existences of "psychological condition deteriorates" adverse outcomes. We also discussed whether there were the psychological condition "deteriorate" adverse outcomes in the group psychological intervention. In the research three, we discussed under the background of psychological practitioners in using questionnaire evaluate whether there were differences. Finally, the study of two cases of four through case follow-up study, we discussed the effect of the questionnaire assessment in actual psychological intervention for psychological practitioners.
The research results indicated that:
(1) Using psychological intervention outcome assessment questionnaire (OQ - 45) in the individual psychological intervention during continuous assessment showed that about 5.7% (2/34) intervention cases existing "deteriorate" status.
(2) Using psychological intervention outcome assessment questionnaire (OQ - 45) in the group psychological intervention during continuous assessment showed that about 7.7% (3/39) intervention cases existing "deteriorate" status.
(3) Virtual situation case design research suggested that questionnaire evaluation result of different background information (age, work experience and education background) psychological intervention from personnel of decision-making influence, there were existed significant differences(χ~2 = 19.033,P<0.001;χ~2=16.246,P<0.001;χ~2=7.791,P<0.01). The results indicated that the evaluation result of questionnaire information more shallow, experience the higher degree of novice type psychological practitioners influenced
(4) Through the case study of two cases of psychological intervention study that followed continuous questionnaire assessment hint (OQ–45), psychological intervention in the clients in the psychological situation change was not a linear relation, and the clients in mood symptoms, interpersonal relationship and social function three dimensions changes in different ways.
This research indicated that, questionnaire was helpful for the assessment psychological intervention "deteriorate" situations timely warning, but different professional background of psychological practitioners of evaluation results vary, the future of using questionnaire should be further discussed to assess their psychological intervention results of actual utility.
引文
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[2] Hannan C., Lambert M.J., Harmon C., et al. A Lab Test and Algorithms for Identifying Clients at Risk for Treatment Failure [J]. JCLP/In Session, 2005, 61(2): 155–163.
[3] Lambert M.J., Ogles B.M. The efficacy and effectiveness of psychotherapy [M]. 5thed. New York: Wiley, 2004: 139-193.
[4] Slade K., Lambert M.J., Harmon S.C. et al. Improving psychotherapy outcome: the use of immediate electronic feedback and reviesed clinical support tools [J].Clinical psychology and psychotherapy, 2008, 15(5):287-303.
[5] Ogles B. M., Lambert, M. J., & Fields, S. A. Essentials of outcome assessment [M]. New York: Wiley, 2002.
[6] Bickman, L., Rosof-Williams, J., Salzer, M. S., et al. What information do clinicians value for monitoring adolescent client progress and outcomes? [J]. Professional Psychology: Research and Practice, 2000, 31: 70–74.
[7] Hatfield D.R., Ogles B.M. The influence of outcome measures in assessing client change and treatment decisions [J]. Journal of clinical psychology, 2006, 62(3): 325-337.
[8] Froyd J.E. A review of practices of psychotherapy outcome measurement [J]. Journal of Mental Health, 1996, 5(1):11-16.
[9] Lambert M.J., Whipple J.L., Hawkins E.J., et al. Is it time for clinicians to routinely track patient progress: a meta-analysis [J]. Clinical Psychology: Science and Practice, 2003; 10(3): 288-301.
[10] Beutler L. E. Comparisons among quality assurance systems: From outcome assessment to clinical utility [J]. Journal of Consulting and Clinical Psychology, 2001, 69: 197–204.
[11] Lambert M.J., Hansen N.B., & Finch A.E. Patient-Focused Research: UsingPatient Outcome Data to Enhance Treatment Effects [J]. Journal of Consulting and Clinical Psychology, 2001, 69(2): 159-172.
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