Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, United States.
Behav Res Ther. 2012 Nov;50(11):699-706. doi: 10.1016/j.brat.2012.08.002. Epub 2012 Aug 13.
Despite long-standing calls for the individualization of treatments for depression, modest progress has been made in this effort. The primary objective of this study was to test two competing approaches to personalizing cognitive-behavioral treatment of depression (viz., capitalization and compensation). Thirty-four adults meeting criteria for Major Depressive Disorder (59% female, 85% Caucasian) were randomized to 16-weeks of cognitive-behavioral treatment in which strategies used were selected based on either the capitalization approach (treatment matched to relative strengths) or the compensation approach (treatment matched to relative deficits). Outcome was assessed with a composite measure of both self-report (i.e., Beck Depression Inventory) and observer-rated (i.e., Hamilton Rating Scale for Depression) depressive symptoms. Hierarchical linear modeling revealed a significant treatment approach by time interaction indicating a faster rate of symptom change for the capitalization approach compared to the compensation approach (d = .69, p = .03). Personalizing treatment to patients' relative strengths led to better outcome than treatment personalized to patients' relative deficits. If replicated, these findings would suggest a significant change in thinking about how therapists might best adapt cognitive-behavioral interventions for depression for particular patients.
尽管长期以来一直呼吁针对抑郁症进行个体化治疗,但在这方面的进展甚微。本研究的主要目的是测试两种竞争方法对抑郁症的认知行为治疗进行个体化处理(即,利用优点和补偿缺点)。34 名符合重度抑郁症标准的成年人(59%为女性,85%为白种人)被随机分配到 16 周的认知行为治疗中,其中使用的策略是基于利用优点(治疗与相对优势相匹配)或补偿缺点(治疗与相对缺陷相匹配)的方法。通过自我报告(即贝克抑郁量表)和观察评估(即汉密尔顿抑郁评定量表)的抑郁症状综合衡量来评估结果。分层线性模型显示,治疗方法与时间的交互作用具有统计学意义,这表明与补偿方法相比,利用优点的方法可以更快地改变症状(d = 0.69,p = 0.03)。根据患者的相对优势对治疗进行个体化处理,比根据患者的相对缺陷进行个体化处理的效果更好。如果这些发现得到复制,将意味着在治疗师如何最好地为特定患者调整认知行为干预治疗抑郁症方面的思维方式将发生重大变化。