Shirk Stephen R, Deprince Anne P, Crisostomo Patrice S, Labus Jennifer
Department of Psychology, University of Denver.
Department of Psychiatry, Stanford University School of Medicine.
Psychotherapy (Chic). 2014 Mar;51(1):167-79. doi: 10.1037/a0034845. Epub 2013 Dec 30.
Four clinical trials have shown that a history of interpersonal trauma is associated with diminished response to cognitive-behavioral therapy (CBT) for adolescent depression. An efficacious CBT protocol for adolescent depression was modified to address cognitive deficits and distortions associated with interpersonal trauma. Initial feasibility, acceptability, and treatment impact of the modified treatment (m-CBT) were evaluated in a randomized effectiveness trial conducted in community clinics. Clients were 43 referred adolescents with a depressive disorder and a history of interpersonal trauma. Adolescents either received m-CBT or usual care (UC) therapy. Results indicated that m-CBT was delivered with good fidelity by community clinicians, but that number of sessions completed was attenuated in both m-CBT and UC. Adolescents reported high levels of treatment satisfaction and acceptability for the new treatment. There were significant reductions in depressive symptoms over time, but no differences in outcomes between groups. Although the new treatment produced promising results, it did not outperform UC. Implications for treatment development are considered.
四项临床试验表明，人际创伤史与青少年抑郁症认知行为疗法（CBT）的反应减弱有关。针对青少年抑郁症的有效CBT方案进行了修改，以解决与人际创伤相关的认知缺陷和扭曲。在社区诊所进行的一项随机有效性试验中，评估了改良治疗（m-CBT）的初步可行性、可接受性和治疗效果。客户是43名被转诊的患有抑郁症且有人际创伤史的青少年。青少年要么接受m-CBT治疗，要么接受常规护理（UC）治疗。结果表明，社区临床医生能够很好地忠实实施m-CBT，但m-CBT组和UC组完成的疗程数量都有所减少。青少年对新治疗的满意度和接受度很高。随着时间的推移，抑郁症状有显著减轻，但两组之间的结果没有差异。尽管新治疗产生了有希望的结果，但它并没有优于UC。文中还考虑了对治疗发展的影响。
