Department of Psychology, MS 3F5, George Mason University, Fairfax, VA 22030, United States.
Behav Res Ther. 2011 Dec;49(12):875-84. doi: 10.1016/j.brat.2011.10.002. Epub 2011 Oct 12.
The current study examined whether depressed outpatients with comorbid SAD respond differently to a cognitive-behavioral group intervention and if so, how and why. Using growth curve modeling, we found evidence that depressed clients with comorbid SAD had rapid improvement in depressive symptoms over the course of treatment and generally did not differ from those without comorbidity in developing close therapeutic relationships and modifying the direction of attentional focus away from the self. Non-linear effects demonstrated that rates of change in depressive symptoms, relationship variables, and focus of attention, were most rapid early in treatment. In contrast to hypotheses, trajectories of change in therapeutic relationships and attentional focus did not mediate the effect of SAD on treatment improvement in depressive symptoms. These findings suggest that comorbid SAD does not have a detrimental effect on the course of depression treatment and group-based treatments can be as beneficial for depressed individuals with comorbid SAD. It may be that group-based treatments for depression provide explicit opportunity for emotional processing in social situations (i.e., exposure) and hence mimic efficacious therapies for SAD.
本研究旨在探讨伴社交焦虑障碍（SAD）的抑郁门诊患者对认知行为团体干预的反应是否存在差异，如果存在，差异的表现形式、产生原因和机制是什么。通过增长曲线建模，我们发现伴 SAD 的抑郁患者在治疗过程中抑郁症状迅速改善，且与无共病患者相比，他们在建立亲密治疗关系和将注意力焦点从自我转移到其他方面的速度并没有差异。非线性效应表明，抑郁症状、关系变量和注意力焦点的变化率在治疗早期最快。与假设相反，治疗关系和注意力焦点变化的轨迹并不能中介 SAD 对改善抑郁症状的治疗效果。这些发现表明，SAD 共病不会对抑郁治疗过程产生不利影响，基于团体的治疗对伴有 SAD 的抑郁个体同样有益。这可能是因为针对抑郁的团体治疗为在社交情境中进行情绪处理（即暴露）提供了明确的机会，从而模拟了对 SAD 有效的治疗方法。
