A parallel-arm, randomized trial of Behavioral Activation Therapy for anhedonia versus mindfulness-based cognitive therapy for adults with anhedonia

IF 4.2 2区心理学 Q1 PSYCHOLOGY, CLINICAL Behaviour Research and Therapy Pub Date : 2024-08-23 DOI:10.1016/j.brat.2024.104620

Paul M. Cernasov , Erin C. Walsh , Gabriela A. Nagy , Jessica L. Kinard , Lisalynn Kelley , Rachel D. Phillips , Angela Pisoni , Joseph Diehl , Kevin Haworth , Jessica West , Louise Freeman , Courtney Pfister , McRae Scott , Stacey B. Daughters , Susan Gaylord , Gabriel S. Dichter , Moria J. Smoski

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Abstract

Background

Anhedonia, deficits in motivation and pleasure, is a transdiagnostic symptom of psychopathology and negative prognostic marker.

Methods

In this randomized, parallel-arm clinical trial, a novel intervention, Behavioral Activation Treatment for Anhedonia (BATA), was compared to an individually administered Mindfulness-Based Cognitive Therapy (MBCT) in a transdiagnostic cohort of adults with clinically significant anhedonia (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Participants received 8–15 individual psychotherapy sessions, once weekly, with either BATA (n = 61) or MBCT (n = 55) and completed repeated self-report assessment of anhedonia and other internalizing symptoms.

Results

Indicators of treatment feasibility were similar across conditions, though MBCT showed a trend towards greater attrition rates than BATA, with an adjusted odd's ratio of 2.04 [0.88, 4.73]. Treatment effects on the primary clinical endpoint of anhedonia symptoms did not significantly differ, with a 14-week estimated difference on the Snaith Hamilton Pleasure Scale (SHAPS) of −0.20 [-2.25, 1.84] points in BATA compared to MBCT (z = 0.19, p = 0.845, d = 0.05). The expected 14-week change in SHAPS scores across conditions was −7.18 [-8.22, −6.15] points (z = 13.6, p < 0.001, d = 1.69). There were no significant differences in the proportion of participants demonstrating reliable and clinically significant improvements in SHAPS scores, or in the magnitude of internalizing symptom reductions.

Limitations

Limitations included a modest sample size, lack of longer-term follow up data, and non-preregistered analytic plan.

Discussion

There was no evidence to support superior clinical efficacy of BATA over MBCT in a transdiagnostic cohort of adults with elevated anhedonia. Both interventions reduced anhedonia symptoms to a comparable magnitude of other existing treatments.

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针对成人厌食症患者的行为激活疗法与正念认知疗法的平行随机试验

背景失乐症是一种跨诊断的精神病理学症状，也是一种消极的预后指标。方法在这项随机平行臂临床试验中，研究人员将一种名为 "失乐症行为激活疗法"（BATA）的新型干预措施与单独施用的 "正念认知疗法"（MBCT）进行了比较，该疗法针对的是具有临床症状的失乐症成人（ClinicalTrials.gov Identifiers NCT02874534 和 NCT04036136）。参加者接受了每周一次、每次8-15个疗程的个人心理治疗，其中包括BATA（61人）或MBCT（55人），并完成了厌世症和其他内化症状的重复自我报告评估。结果不同条件下的治疗可行性指标相似，但MBCT的减员率呈高于BATA的趋势，调整后的奇偶比为2.04 [0.88, 4.73]。治疗对主要临床终点失乐症状的影响没有显著差异，与 MBCT 相比，BATA 在斯奈思-汉密尔顿快乐量表（SHAPS）上的 14 周估计差异为 -0.20 [-2.25, 1.84] 分（z = 0.19, p = 0.845, d = 0.05）。在不同条件下，SHAPS评分的14周预期变化为-7.18 [-8.22, -6.15]分（z = 13.6, p < 0.001, d = 1.69）。在SHAPS评分中显示出可靠且有临床意义的改善的参与者比例，以及内化症状减少的程度方面，没有明显的差异。讨论没有证据表明，在厌学情绪升高的成人跨诊断队列中，BATA的临床疗效优于MBCT。这两种干预方法对失乐症症状的缓解程度与其他现有治疗方法相当。

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来源期刊

Behaviour Research and Therapy PSYCHOLOGY, CLINICAL-

CiteScore

7.50

自引率

7.30%

发文量

148

期刊介绍： The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.