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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
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
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 PSYCHIATRY 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
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
Response to Philips et al.: Several Fundamental Misconceptions about Evidence-Based Practice. 对 Philips 等人的回应:关于循证实践的几个基本误解。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-09-05 DOI: 10.1159/000540903
Sophie Juul, Janus Christian Jakobsen, Emilie Hestbaek, Caroline Barkholt Kamp, Markus Harboe Olsen, Marie Rishede, Frederik Weischer Frandsen, Sune Bo, Stig Poulsen, Per Sørensen, Anthony Bateman, Sebastian Simonsen
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引用次数: 0
The Person-Centred Clinical Interview. 以人为本的临床访谈。
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-03 DOI: 10.1159/000539055
Tom Sensky
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引用次数: 0
The Future of Enhanced Psychotherapy: Towards Precision Psychotherapy. 强化心理疗法的未来:迈向精准心理治疗
IF 16.3 1区 医学 Q1 PSYCHIATRY Pub Date : 2024-01-01 Epub Date: 2024-06-26 DOI: 10.1159/000539022
Stephan Zipfel, Wolfgang Lutz, Silvia Schneider, Elisabeth Schramm, Jaime Delgadillo, Katrin E Giel
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引用次数: 0
期刊
Psychotherapy and Psychosomatics
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