Schlögelhofer Monika, Willinger Ulrike, Wiesegger Georg, Eder Harald, Priesch Margrit, Itzlinger Ulrike, Bailer Ursula, Schosser Alexandra, Leisch Friedrich, Aschauer Harald
Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University Vienna, Austria.
Psychol Psychother. 2014 Jun;87(2):178-90. doi: 10.1111/papt.12008. Epub 2013 May 17.
Cognitive behavioural guided self-help has been shown to be effective in mild and moderate depressive disorder. It is not known, however, if it is effective in individuals with partially remitted depressive disorder, which is a serious clinical problem in up to 50-60% of treated patients. This study is the first one to examine the clinical benefit of this intervention in this patient population.
For the purpose of this study, a single-blind, randomized controlled design was used.
We randomized 90 individuals with partially remitted depressive disorder either to cognitive behavioural guided self-help plus psychopharmacotherapy (n = 49) or psychopharmacotherapy alone (n = 41). They were clinically assessed at regular intervals with ratings of depressive symptoms and stress-coping strategies over a 3-week run-in period and a 6-week treatment period.
After 6 weeks, intention-to-treat analysis (n = 90) showed that patients treated with cognitive behavioural guided self-help plus psychopharmacotherapy did not have significantly lower scores on the Hamilton Rating Scale of Depression (17-item version; HRSD-17) and on the Beck Depression Inventory (BDI) compared to patients treated with psychopharmacotherapy alone. When negative stress-coping strategies were considered, there was a significant difference between the two groups at the end of treatment with respect to the BDI but not to the HRSD-17.
Guided self-help did not lead to a significant reduction in symptom severity in patients with partially remitted depressive disorder after a 6-week intervention. However, the intervention leads to a reduction of negative stress-coping strategies.
Cognitive behavioural guided self-help did not significantly improve depressive symptoms measured with the Hamilton Rating Scale of Depression (17-item version; HRSD-17) in patients with partially remitted depressive disorder. Improvements were found in reducing negative stress-coping strategies for those allocated to the cognitive behavioural guided self-help, which significantly improved Beck Depression Inventory but not HRSD-17. These findings suggest that cognitive behavioural guided self-help may offer some assistance in managing negative stress-coping strategies.
认知行为指导自助疗法已被证明对轻度和中度抑郁症有效。然而，对于部分缓解的抑郁症患者，该疗法是否有效尚不清楚，这在高达50%-60%的接受治疗的患者中是一个严重的临床问题。本研究是首个检验该干预措施对这一患者群体临床益处的研究。
为了本研究的目的，采用了单盲随机对照设计。
我们将90例部分缓解的抑郁症患者随机分为认知行为指导自助疗法联合心理药物治疗组（n = 49）和单纯心理药物治疗组（n = 41）。在为期3周的导入期和6周的治疗期内，定期对他们进行临床评估，包括抑郁症状评分和压力应对策略评估。
6周后，意向性分析（n = 90）显示，与单纯接受心理药物治疗的患者相比，接受认知行为指导自助疗法联合心理药物治疗的患者在汉密尔顿抑郁量表（17项版本；HRSD-17）和贝克抑郁量表（BDI）上的得分并没有显著降低。当考虑消极压力应对策略时，两组在治疗结束时在BDI上存在显著差异，但在HRSD-17上没有差异。
经过6周的干预，指导自助疗法并未导致部分缓解的抑郁症患者的症状严重程度显著降低。然而，该干预措施可减少消极压力应对策略。
认知行为指导自助疗法在部分缓解的抑郁症患者中，并未显著改善用汉密尔顿抑郁量表（17项版本；HRSD-17）测量的抑郁症状。对于分配到认知行为指导自助疗法组的患者，在减少消极压力应对策略方面有改善，这显著改善了贝克抑郁量表，但未改善HRSD-17。这些发现表明，认知行为指导自助疗法可能在管理消极压力应对策略方面提供一些帮助。
