Department of Psychology, Southern Methodist University, Dedman College, PO Box 750442, Dallas, TX 75275, USA.
Psychother Psychosom. 2012;81(3):153-60. doi: 10.1159/000334909. Epub 2012 Mar 3.
Compared to nonanxious depressed patients, anxious depressed patients respond less to pharmacotherapy, prompting consideration of alternate treatments. Based on the transdiagnostic principles of cognitive therapy (CT), we predicted that anxious depressed patients would respond as well to CT as nonanxious depressed patients.
Adults (n = 523) with recurrent major depressive disorder received 12-14 weeks of CT as part of the Continuation Phase Cognitive Therapy Relapse Prevention Trial. Anxious depressed patients (n = 264; 50.4%) were compared to nonanxious depressed patients (n = 259; 49.6%) on demographic variables, initial severity, attrition, and rates and patterns of response and remission.
Anxious depressed patients presented with greater illness severity and had significantly lower response (55.3 vs. 68.3%) and remission rates (26.9 vs. 40.2%) based on clinician-administered measures. By contrast, smaller between-group differences for attrition, and for response (59.1 vs. 64.9%) and remission (41.7 vs. 48.7%) rates on self-report measures were not significant. Further, anxious depressed patients had greater speed of improvement on self-reported anxiety symptom severity and clinician-rated depressive and anxiety symptom severity measures.
Consistent with prior reports, anxious depressed patients presented with greater severity and, following CT, had lower response and remission rates on clinician-administered scales. However, anxious depressed patients improved more rapidly and response and remission rates on self-report measures were not significantly different from nonanxious depressed patients. Our findings suggest that anxious depressed patients may simply need additional time or more CT sessions to reach outcomes fully comparable to those of less anxious patients.
与非焦虑抑郁患者相比，焦虑抑郁患者对药物治疗的反应较差，这促使人们考虑采用替代疗法。基于认知疗法（CT）的跨诊断原则，我们预测焦虑抑郁患者对 CT 的反应与非焦虑抑郁患者一样好。
作为延续阶段认知治疗预防复发试验的一部分，患有复发性重度抑郁症的成年人（n = 523）接受了 12-14 周的 CT。将焦虑抑郁患者（n = 264；50.4%）与非焦虑抑郁患者（n = 259；49.6%）进行比较，比较的指标包括人口统计学变量、初始严重程度、脱落率，以及反应和缓解的速度和模式。
焦虑抑郁患者的疾病严重程度更高，根据临床医生评估的指标，他们的反应率（55.3%对 68.3%）和缓解率（26.9%对 40.2%）明显较低。相比之下，基于自我报告的指标，两组间的脱落率差异较小，反应率（59.1%对 64.9%）和缓解率（41.7%对 48.7%）差异也不显著。此外，焦虑抑郁患者在自我报告的焦虑症状严重程度和临床医生评估的抑郁和焦虑症状严重程度的测量指标上，改善速度更快。
与之前的报告一致，焦虑抑郁患者的严重程度更高，在接受 CT 治疗后，根据临床医生评估的量表，他们的反应率和缓解率较低。然而，焦虑抑郁患者在自我报告的量表上的改善速度更快，且反应率和缓解率与非焦虑抑郁患者没有显著差异。我们的研究结果表明，焦虑抑郁患者可能只是需要额外的时间或更多的 CT 疗程，才能达到与非焦虑患者完全可比的结果。
