Watkins Ed, Scott Jan, Wingrove Janet, Rimes Katharine, Bathurst Neil, Steiner Herbert, Kennell-Webb Sandra, Moulds Michelle, Malliaris Yanni
Mood Disorders Centre, School of Psychology, University of Exeter, Exeter EX4 4QG, UK.
Behav Res Ther. 2007 Sep;45(9):2144-54. doi: 10.1016/j.brat.2006.09.018. Epub 2007 Mar 26.
The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.
慢性复发性抑郁症的治疗是新干预措施开发的重点。抑郁症急性治疗后残留症状的持续存在是慢性抑郁症和进一步复发/再发的危险因素。这个开放性病例系列提供了首个关于针对残留抑郁症的认知行为疗法的数据，该疗法明确针对抑郁性沉思。沉思已被确定为抑郁症发作和维持的关键因素，在抑郁症缓解后仍会持续升高。连续招募了14名符合药物难治性残留抑郁症标准的参与者[佩克尔，E.S.，斯科特，J.，泰斯戴尔，J.D.，约翰逊，A.L.，加兰，A.，摩尔，R.等人，1999年。认知疗法预防残留抑郁症复发的对照试验。《普通精神病学档案》56，829 - 835]，对他们进行了长达12周、每周60分钟的个体治疗。治疗特别侧重于通过功能分析、体验/意象练习和行为实验，帮助患者从无益的思维方式转变为有益的思维方式。治疗在抑郁症状、沉思和共病方面产生了显著改善：71%的患者有反应（汉密尔顿抑郁量表评分降低50%），50%的患者实现了完全缓解。治疗抑郁性沉思似乎能使抑郁症和共病得到普遍改善。这项研究提供了初步证据，表明以沉思为重点的认知行为疗法可能是治疗药物难治性残留抑郁症的有效方法。
