Davies Carolyn D, Niles Andrea N, Pittig Andre, Arch Joanna J, Craske Michelle G
Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
J Behav Ther Exp Psychiatry. 2015 Mar;46:35-43. doi: 10.1016/j.jbtep.2014.08.002. Epub 2014 Aug 23.
Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders.
Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline.
Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome.
Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables.
Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts.
确定某种治疗方法对谁以及在何种情况下最为有效，是迈向个性化医疗的关键一步。当前研究在一项比较认知行为疗法（CBT）和接纳与承诺疗法（ACT）治疗焦虑症的随机临床试验中，检验了治疗前的生理和行为变量作为结果的预测因素和调节因素。
60名符合《精神疾病诊断与统计手册》第四版（DSM-IV）定义的主要焦虑症患者完成了12节CBT或ACT治疗课程。在进入治疗前测量基线生理和行为变量。在治疗前、治疗后以及从基线开始的6个月和12个月随访时评估自我报告的焦虑症状。
治疗前较高的心率变异性与ACT和CBT的较差结果相关。对于行为回避程度高的个体，ACT的效果优于CBT。实验室任务期间的主观焦虑水平不能预测或调节治疗结果。
由于每种疾病的样本量较小，未对特定疾病的预测因素进行测试。未来的研究应在更大的样本中以及针对其他结果变量检验这些预测因素。
较低的心率变异性被确定为总体结果的预后指标，而高行为回避被确定为ACT相对于CBT产生更好结果的指示性指标。将治疗前的生理和行为变量作为结果的预测因素和调节因素进行研究，可能有助于指导未来的治疗匹配工作。
