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Therapeutic Reactance as a Predictor of Outcome in the Treatment of Chronic Depression.
Authors:Arnow  Bruce A; Manber  Rachel; Blasey  Christine; Klein  Daniel N; Blalock  Janice A; Markowitz  John C; Rothbaum  Barbara O; Rush  A John; Thase  Michael E; Riso  Lawrence P; Vivian  Dina; McCullough  James P  Jr; Keller  Martin B
Abstract:This study examined whether reactance would negatively influence treatment outcome in 347 patients diagnosed with chronic forms of depression and treated at 9 sites with either Nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), or combination therapy. Contrary to our hypotheses, reactance positively predicted treatment outcome in CBASP on 2 of 4 scales. These effects were independent of the therapeutic alliance, which also positively predicted outcome. Reactance did not predict outcome in the groups receiving medication alone or in combination with CBASP. The findings suggest that reactance may be an asset in psychotherapy among chronically depressed individuals and that reactant patients can benefit from directive psychotherapy when therapists flexibly respond to perturbations in the therapeutic relationship. Results support the importance of Aptitude × Treatment interactions in psychotherapy outcome. The direction and significance of such interactions may vary with different forms of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Keywords:therapeutic reactance  therapeutic alliance  cognitive-behavioral psychotherapy  chronic major depression  prediction  outcomes  drug therapy  combination treatment  Nefazodone
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