Alpert Medical School of Brown University, RI, USA.
Behav Modif. 2013 May;37(3):324-55. doi: 10.1177/0145445512465173. Epub 2012 Dec 6.
Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial.
研究表明，认知行为疗法在治疗严重非精神病性重度抑郁症或原发性精神病性障碍（如精神分裂症）方面，比单独使用药物治疗效果更显著。然而，之前的研究并未证明心理治疗对有精神病特征的重度抑郁症的疗效。在这项初步的治疗开发研究中，我们对一种新的行为干预措施进行了开放性试验，该措施结合了行为激活和接受与承诺疗法的元素，用于治疗抑郁和精神病。对 14 名有精神病特征的重度抑郁障碍患者在药物治疗的基础上，提供长达 6 个月的接受性抑郁和精神病治疗（ADAPT）。患者报告了高度的治疗可信度和可接受性。结果表明，通过治疗后的随访，患者在抑郁和精神病症状以及社会心理功能方面都取得了显著且持续的改善。此外，干预措施的目标过程（如接受、正念、价值观）在治疗过程中显著改善，症状的变化与过程的变化相关。结果表明，ADAPT 联合药物治疗是一种有前途的精神病性抑郁症治疗方法，应该在未来的随机试验中进行测试。
