Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA.
J Consult Clin Psychol. 2013 Aug;81(4):615-26. doi: 10.1037/a0032879. Epub 2013 Apr 29.
We tested nomothetic and idiographic convergence and change in 3 symptom measures during acute-phase cognitive therapy (CT) for depression and compared outcomes among patients showing different change patterns.
Outpatients (N = 362; 69% women; 85% White; age M = 43 years) with recurrent major depressive disorder according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) completed the Hamilton Rating Scale for Depression (Hamilton, 1960), Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), and Inventory for Depressive Symptomatology-Self-Report (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996) on 14 occasions as well as pre/post-CT measures of social-interpersonal functioning and negative cognitive content.
The 3 symptom measures marked the same severity and change constructs, and we offer improved formulas for intermeasure score conversions via their common factor. Pre/post-CT symptom reductions were large (ds = 1.71-1.92), and nomothetic symptom curves were log-linear (larger improvements earlier and smaller improvements later in CT). Nonetheless, only 30% of individual patients showed clear log-linear changes, whereas other patients showed linear (e.g., steady decreases; 20%), 1-step (e.g., a quick drop; 16%), and unclassified (34%) patterns. Log-linear, linear, and 1-step patients were generally similar to one another and superior to unclassified patients post-CT in symptom levels, response and stable remission rates, social-interpersonal functioning, and cognitive content (median d = 0.69).
Reaching a low-symptom "destination" at the end of CT via any coherent "path" is more important in the short term than which path patients take. We discuss implications for theories of change, clinical monitoring of individuals' progress in CT, and the need to investigate long-term outcomes of patients with differing patterns of symptom change.
我们在急性认知治疗（CT）期间测试了 3 种症状测量的共同方法和个体方法的收敛和变化，并比较了表现出不同变化模式的患者的治疗结果。
根据《精神障碍诊断与统计手册》（第 4 版，文本修订版；美国精神病学协会，2000）标准，362 名复发性重度抑郁症门诊患者（69%为女性；85%为白人；年龄 M=43 岁）完成了汉密尔顿抑郁量表（Hamilton，1960）、贝克抑郁量表（Beck、Ward、Mendelson、Mock 和 Erbaugh，1961）和抑郁症状自评量表（Rush、Gullion、Basco、Jarrett 和 Trivedi，1996）共 14 次，并在 CT 前后测量了社会人际功能和消极认知内容。
3 种症状测量方法标记了相同的严重程度和变化结构，我们通过它们的共同因素提供了改进的跨测量评分转换公式。CT 前后的症状减轻量较大（ds=1.71-1.92），共同方法症状曲线呈对数线性（CT 早期改善较大，后期改善较小）。然而，只有 30%的个体患者表现出明显的对数线性变化，而其他患者则表现出线性（例如，持续下降；20%）、1 步（例如，快速下降；16%）和未分类（34%）模式。对数线性、线性和 1 步患者在 CT 后在症状水平、反应和稳定缓解率、社会人际功能和认知内容方面通常与未分类患者相似（中位数 d=0.69）。
在短期内，通过任何连贯的“路径”在 CT 结束时达到低症状“目的地”比患者选择的路径更为重要。我们讨论了对变化理论的影响、对个体 CT 进展的临床监测，以及对具有不同症状变化模式的患者进行长期结局研究的必要性。
