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One-Day Peer-Delivered Cognitive Behavioral Therapy-Based Workshops for Postpartum Depression: A Randomized Controlled Trial. 基于认知行为疗法的产后抑郁研讨会:随机对照试验
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-01-25 DOI: 10.1159/000536040
Zoryana Babiy, Haley Layton, Calan D Savoy, Feng Xie, June S L Brown, Peter J Bieling, David L Streiner, Mark A Ferro, Ryan J Van Lieshout

Introduction: Myriad treatment barriers prevent birthing parents with postpartum depression (PPD) from receiving timely treatment. We aimed to determine whether a peer-delivered online 1-day cognitive behavioral therapy (CBT)-based workshop added to treatment as usual (TAU) improves PPD and its comorbidities and is more cost-effective than TAU alone.

Methods: This parallel-group, randomized controlled trial took place in Ontario, Canada (June 7, 2021, to February 18, 2022). Participants were ≥18 years old, had an infant ≤12 months old, and an Edinburgh Postnatal Depression Scale (EPDS) score ≥10. Participants were allocated to receive the workshop plus TAU (n = 202) or TAU and waitlisted to complete the workshop 12 weeks later (n = 203). The primary outcome was change in PPD (EPDS score) from enrollment to 12 weeks later. The secondary outcome was cost-effectiveness and tertiary outcomes included anxiety, social support, partner relationship quality, the mother-infant relationship, parenting stress, and infant temperament.

Results: Participants had a mean age of 32.3 years (SD = 4.30) and 65% were White. The workshop led to a significant reduction in EPDS scores (15.95-11.37; d = 0.92, p < 0. 01) and was associated with higher odds of exhibiting a clinically significant decrease in EPDS scores (OR = 2.03; 95% CI: 1.26-3.29). The workshop plus TAU was more cost-effective than TAU alone. It also led to improvements in postpartum anxiety, infant-focused anxiety, parenting stress, and infant temperament.

Conclusions: Peer-delivered 1-day CBT-based workshops can improve PPD and are a potentially scalable low-intensity treatment that could help increase treatment access.

导言:各种治疗障碍阻碍了患有产后抑郁症(PPD)的分娩父母及时接受治疗。我们的目的是确定在常规治疗(TAU)的基础上增加一个由同伴提供的、基于认知行为疗法(CBT)的为期 1 天的在线研讨会,是否能改善产后抑郁症及其合并症,是否比单独使用常规治疗更具成本效益:这项平行分组随机对照试验在加拿大安大略省进行(2021 年 6 月 7 日至 2022 年 2 月 18 日)。参与者年龄≥18岁,婴儿≤12个月,爱丁堡产后抑郁量表(EPDS)评分≥10分。参加者被分配接受工作坊加TAU(n = 202)或TAU并等待12周后完成工作坊(n = 203)。主要结果是入学至12周后PPD(EPDS评分)的变化。第二结果是成本效益,第三结果包括焦虑、社会支持、伴侣关系质量、母婴关系、养育压力和婴儿气质:参与者的平均年龄为 32.3 岁(SD = 4.30),65% 为白人。工作坊显著降低了 EPDS 分数(15.95-11.37;d = 0.92,p < 0. 01),而且 EPDS 分数出现临床显著下降的几率更高(OR = 2.03;95% CI:1.26-3.29)。工作坊加 TAU 比单独使用 TAU 更具成本效益。它还能改善产后焦虑、婴儿焦虑、养育压力和婴儿脾气:由同伴提供的为期一天的基于 CBT 的工作坊可以改善 PPD,是一种潜在的可扩展低强度治疗方法,有助于提高治疗的可及性。
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引用次数: 0
Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment. 早发慢性抑郁症患者的长期轨迹纵向集群:广泛心理治疗后两年的自然随访。
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2023-12-28 DOI: 10.1159/000535005
Moritz Elsaesser, Bernd Feige, Levente Kriston, Lea Schumacher, Jasmin Peifer, Martin Hautzinger, Martin Härter, Elisabeth Schramm

Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed.

Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression.

Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3-4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64).

Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

简介在临床试验中,分析的大多是重复横断面测量的组级治疗效果。然而,个体症状特征的实质性异质性和治疗效果的可变性往往被忽视,尤其是在长期病程中。为了提供有效的个性化治疗,迫切需要对这些特征进行研究:方法:对认知行为分析系统心理疗法(CBASP)或支持性心理疗法(SP)治疗一年后,随访104周的抑郁严重程度评分进行分析。通过纵向聚类分析和多项式逻辑回归分析,研究了早发性慢性抑郁症最大心理疗法试验之一的个体内部轨迹:N = 188 名早发慢性抑郁症患者的两年治疗后轨迹被分为四个原型群组。总体而言,16.0%的患者病情得到缓解(第 1 组),其中大部分患者在两年随访期间没有接受任何治疗。然而,84.0%的患者仍有阈下抑郁症状(第 2 组,37.2%)或重度抑郁症状(第 3-4 组,46.8%),平均一半以上的随访时间用于药物和心理治疗。分层回归分析表明,之前接受过CBASP或SP治疗的研究并不能显著预测群组分配,而基线变量占解释变异的很大比例(R2 N = 0.64):结论:虽然一些患者在两年的随访中病情得到稳定缓解,但无论之前是否接受过CBASP或SP的研究治疗,大多数患者都会出现阈值以下或重度抑郁症状。这就需要从长远角度出发,实施分期和创新治疗方法,如序贯模式或模块化心理疗法。
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引用次数: 0
Effectiveness of Schema Therapy versus Cognitive Behavioral Therapy versus Supportive Therapy for Depression in Inpatient and Day Clinic Settings: A Randomized Clinical Trial. 住院和日间诊所抑郁症患者接受模式疗法与认知行为疗法和支持疗法的疗效对比:随机临床试验
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-01-04 DOI: 10.1159/000535492
Johannes Kopf-Beck, Celina L Müller, Jeanette Tamm, Julia Fietz, Nils Rek, Leah Just, Zoe Ilona Spock, Katharina Weweck, Keisuke Takano, Martin Rein, Martin E Keck, Samy Egli

Introduction: Schema therapy (ST) reduces depressive symptoms, but clinical trials have not investigated its effectiveness for patients suffering from severe forms of depression and high rates of comorbidities. There is high demand for exploring and improving treatments for this patient group. The objective of the current study was to evaluate whether ST is more effective than individual supportive therapy (IST) and noninferior compared with cognitive behavioral therapy (CBT) in treating depression.

Methods: For this clinical trial, medicated patients were recruited in inpatient and day clinic settings. The major inclusion criteria were age between 18 and 75 years and primary diagnosis of depression without psychotic symptoms. A total of 292 participants were randomized to ST, CBT, or IST and received 7 weeks of psychotherapy (up to 14 individual and 14 group sessions). The primary outcome was change in depression severity after treatment measured by Beck Depression Inventory-II. Primary test for efficacy was superiority of ST over IST. Secondary test was noninferiority of ST compared with CBT. Multilevel modeling was conducted. The results at 6-month follow-up were explored.

Results: Across treatment, ST was not superior to IST. Secondary outcome analyses and completer analyses showed similar results. However, ST showed clinically relevant noninferiority compared with CBT.

Conclusion: ST for depression as part of a psychiatric care program showed clinical noninferiority compared to CBT, without being superior to IST. ST represents a potentially useful addition to the therapeutic repertoire for the treatment of depression but its efficacy, including long-term efficacy, should be evaluated further.

简介模式疗法(ST)可减轻抑郁症状,但临床试验尚未研究其对严重抑郁症和高合并症患者的疗效。针对这一患者群体,探索和改进治疗方法的需求很高。本研究的目的是评估 ST 在治疗抑郁症方面是否比个体支持疗法(IST)更有效,以及与认知行为疗法(CBT)相比是否不具劣势:这项临床试验招募了住院和日间诊所的药物治疗患者。主要纳入标准为年龄在 18 岁至 75 岁之间,主要诊断为无精神病症状的抑郁症。共有 292 名参与者被随机分配到 ST、CBT 或 IST,并接受了为期 7 周的心理治疗(最多 14 次个人治疗和 14 次小组治疗)。主要结果是治疗后抑郁严重程度的变化,由贝克抑郁量表-II测量。主要疗效检验是 ST 优于 IST。次要检验是 ST 与 CBT 相比的非劣效性。进行了多层次建模。结果:结果:在所有治疗中,ST 并不优于 IST。次要结果分析和完成者分析显示了相似的结果。然而,与 CBT 相比,ST 显示出临床相关的非劣势:作为精神病治疗项目的一部分,ST治疗抑郁症的临床效果不优于CBT,但也不优于IST。ST是对抑郁症治疗的一种潜在有益补充,但其疗效(包括长期疗效)仍有待进一步评估。
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引用次数: 0
Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial. 基于互联网和移动设备的亚临床焦虑症和抑郁症干预措施(ICare Prevent)的疗效:三臂随机对照试验的结果。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-04-30 DOI: 10.1159/000536149
Anna-Carlotta Zarski, Kiona K Weisel, Thomas Berger, Tobias Krieger, Michael P Schaub, Matthias Berking, Dennis Görlich, Corinna Jacobi, David D Ebert

Introduction: Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms.

Objective: This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC).

Methods: Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported.

Results: Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI.

Conclusions: A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.

导言:尽管亚临床焦虑症和抑郁症经常并发,但有关这两种疾病的干预效果的研究却十分有限。基于互联网和移动设备的干预(IMIs)有望帮助亚临床症状患者:本研究旨在评估在个体化(IG-IMI)或自动化(AG-IMI)指导下,跨诊断和自我定制的 IMI 在降低亚临床焦虑症和抑郁症状严重程度方面的疗效,并与照常就诊(WLC)的候补对照组进行比较:参与者包括 566 名有亚临床焦虑(GAD-7 ≥ 5)和/或抑郁(CES-D ≥16)症状的成年人,他们不符合全症状抑郁或焦虑障碍的标准。在一项三臂随机临床试验中,参与者被随机分配到认知行为 7 节 IMI 加 IG-IMI (n = 186)或 AG-IMI(n = 189)或 WLC(n = 191)的强化课程中。主要结果包括随机分组 8 周后观察者评定的焦虑(HAM-A)和抑郁(QIDS)症状严重程度,由盲法评定者通过电话进行评估。报告了 6 个月和 12 个月的随访结果:结果:与 WLC 相比,IG-IMI(焦虑:d = 0.45,抑郁:d = 0.43)和 AG-IMI(焦虑:d = 0.31,抑郁:d = 0.32)的症状严重程度明显降低,影响程度为轻微至中等。在主要结果方面,不同指导方式之间没有明显差异。6 个月后,HAM-A 有明显效果,AG-IMI 更优。参与者平均完成了 85.38% 的 IG-IMI 和 77.38% 的 AG-IMI:跨诊断、自我定制的 IMI 可以减轻亚临床焦虑和抑郁症状的严重程度,但 12 个月的长期效果并不明显。自动指导有望在广泛的预防措施中提高 IMI 的可扩展性。
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引用次数: 0
The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial. 辩证行为疗法与模式疗法对边缘型人格障碍的疗效比较:随机临床试验
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-10 DOI: 10.1159/000538404
Nele Assmann, Anja Schaich, Arnoud Arntz, Till Wagner, Philipp Herzog, Daniel Alvarez-Fischer, Valerija Sipos, Kamila Jauch-Chara, Jan Philipp Klein, Michael Hüppe, Ulrich Schweiger, Eva Fassbinder

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD.

Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up.

Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: -0.58-7.22], p = 0.094, d = -24 [-0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88-3.02], ST: d = 1.78 [1.26-2.29]).

Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.

导言:在边缘型人格障碍(BPD)的治疗中,辩证行为疗法(DBT)和模式疗法(ST)都得到了经验上的支持;但这两种疗法从未被直接比较过。本研究探讨了这两种疗法在治疗 BPD 患者方面是否更有效:在这项随机、平行组、评分者盲法临床试验中,一家三级门诊治疗中心(德国吕贝克)招募了年龄在 18 岁至 65 岁之间、主要诊断为 BPD 的门诊患者。参与者随机接受 DBT 或 ST 治疗,在 1.5 年的时间里,每周进行一次个人治疗和一次小组治疗。主要结果是在1年的自然随访中用边缘型人格障碍严重程度指数的平均分评估BPD症状的严重程度:2014年11月26日至2018年12月14日期间,我们共招募了164名患者(平均年龄=33.7 [SD = 10.61]岁)。其中,81 人(49.4%)接受了 ST 治疗,83 人(50.6%)接受了 DBT 治疗,总体而言,130 人(79.3%)为女性。采用广义线性混合模型进行的意向治疗分析表明,在为期一年的自然随访中,DBT 和 ST 在 BPDSI 总分上没有显著差异(平均差异为 3.32 [95% CI:-0.58-7.22],P = 0.094,d = -24 [-0.69; 0.20]),DBT 的得分较低。两组患者的随访前效应大小都很大(DBT:d = 2.45 [1.88-3.02];ST:d = 1.78 [1.26-2.29]):结论:两个治疗组的患者均有显著改善,这表明即使是患有严重 BPD 和各种合并症的患者,也能成功接受 DBT 和 ST 治疗。还需要再进行一次非劣效性试验,以证明这两种治疗方法是否同样有效。该试验已在德国临床试验注册中心(DRKS00011534)进行了回顾性注册,未对方案进行修改。
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引用次数: 0
Erratum. 勘误。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-24 DOI: 10.1159/000540410
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引用次数: 0
Flaws in the Design of a Randomized Controlled Trial Comparing Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder. 一项随机对照试验的设计缺陷--短期与长期心理治疗边缘型人格障碍的比较。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-07-31 DOI: 10.1159/000540309
Björn Philips, Falk Leichsenring, Henning Jordet, Sigmund Karterud
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引用次数: 0
Will Interviewing Become a Lost Art? 面试会成为一门失传的艺术吗?
IF 22.8 1区 医学 Q1 Psychology Pub Date : 2024-01-01 Epub Date: 2024-03-08 DOI: 10.1159/000537783
Steven L Dubovsky
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引用次数: 0
Treating Posttraumatic Stress Disorder: The Complexities of the Clinical Realm. 治疗创伤后应激障碍:临床领域的复杂性。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-05-20 DOI: 10.1159/000538954
Ulrich Schnyder
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引用次数: 0
Emotional Changes during Imagery Rescripting of Aversive Social Memories in Social Anxiety Disorder: A Randomized Controlled Trial. 社交焦虑症患者在对厌恶性社交记忆进行意象重描时的情绪变化:随机对照试验
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-26 DOI: 10.1159/000539402
Rosa J Seinsche, Susanne Fricke, Marie K Neudert, Raphaela I Zimmer, Rudolf Stark, Andrea Hermann

Introduction: Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention.

Objective: This randomized controlled trial investigated self-reported affective and physiological responses during ImRs.

Methods: Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases.

Results: Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline.

Conclusions: These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs.

简介意象重描(ImRs)是一种针对厌恶记忆的心理治疗干预方法。在三个阶段的干预过程中,患者会重新体验他们的厌恶记忆(第一阶段),从成人的角度观察场景,并进行干预以帮助以前的自己(第二阶段),然后带着积极的变化再次体验(第三阶段)。以往的研究很少对干预过程中的情绪和调节过程进行调查:这项随机对照试验调查了在 ImRs 过程中自我报告的情感和生理反应:77名社交焦虑症(SAD)患者被随机分配到单次ImRs或针对厌恶性社交记忆的对照干预(回忆和讨论记忆)中。在基线和干预阶段结束后,对患者的心率(HR)和心率变异性(HRV)进行评估,并对积极和消极情绪进行事后评分:结果:与对照干预相比,ImRs 导致消极情绪从基线到第一阶段的最初增加,以及随后更大(第一阶段到第二阶段)和更稳定(第二阶段到第三阶段)的消极情绪减少/积极情绪增加。在生理层面上,与对照干预相比,在 ImRs 期间,与基线相比,第一阶段的平均心率和第三阶段的心率变异均显著升高:这些结果进一步说明了情绪反应在 ImRs 期间不同反应水平上的具体顺序,与已知的情绪处理理论和假定的 ImRs 机制相一致。
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引用次数: 0
期刊
Psychotherapy and Psychosomatics
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