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正念认知疗法对有和无当前抑郁发作的复发性抑郁障碍患者的疗效:一项随机对照试验。

The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial.

机构信息

Department of Psychiatry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

出版信息

Psychol Med. 2012 May;42(5):989-1001. doi: 10.1017/S0033291711002054. Epub 2011 Oct 3.

Abstract

BACKGROUND

The aim of this study is to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in addition to treatment as usual (TAU) for recurrent depressive patients with and without a current depressive episode.

METHOD

A randomized, controlled trial comparing MBCT+TAU (n=102) with TAU alone (n=103). The study population consisted of patients with three or more previous depressive episodes. Primary outcome measure was post-treatment depressive symptoms according to the Hamilton Rating Scale for Depression. Secondary outcome measures included the Beck Depression Inventory, rumination, worry and mindfulness skills. Group comparisons were carried out with linear mixed modelling, controlling for intra-group correlations. Additional mediation analyses were performed. Comparisons were made between patients with and without a current depressive episode.

RESULTS

Patients in the MBCT+TAU group reported less depressive symptoms, worry and rumination and increased levels of mindfulness skills compared with patients receiving TAU alone. MBCT resulted in a comparable reduction of depressive symptoms for patients with and without a current depressive episode. Additional analyses suggest that the reduction of depressive symptoms was mediated by decreased levels of rumination and worry.

CONCLUSIONS

The study findings suggest that MBCT is as effective for patients with recurrent depression who are currently depressed as for patients who are in remission. Directions towards a better understanding of the mechanisms of action of MBCT are given, although future research is needed to support these hypotheses.

摘要

背景

本研究旨在考察正念认知疗法(MBCT)在常规治疗(TAU)基础上对有或无当前抑郁发作的复发性抑郁患者的疗效。

方法

一项比较 MBCT+TAU(n=102)与 TAU 单独治疗(n=103)的随机对照试验。研究人群包括有三次或更多次既往抑郁发作的患者。主要结局测量为汉密尔顿抑郁量表(Hamilton Rating Scale for Depression)评估的治疗后抑郁症状。次要结局测量包括贝克抑郁量表、沉思、担忧和正念技能。采用线性混合模型进行组间比较,控制组内相关性。进行了额外的中介分析。对有和无当前抑郁发作的患者进行了比较。

结果

与接受 TAU 单独治疗的患者相比,MBCT+TAU 组的患者报告的抑郁症状、担忧和沉思较少,正念技能水平较高。MBCT 对有和无当前抑郁发作的患者的抑郁症状均有类似的减轻作用。进一步的分析表明,抑郁症状的减轻是通过降低沉思和担忧的水平来介导的。

结论

研究结果表明,MBCT 对当前抑郁的复发性抑郁患者与缓解期的患者同样有效。虽然需要进一步的研究来支持这些假设,但研究给出了对 MBCT 作用机制的更好理解的方向。

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