Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
Department of Psychology, Vanderbilt University, Nashville, TN, USA.
Clin Psychol Rev. 2015 Nov;41:16-26. doi: 10.1016/j.cpr.2015.02.003. Epub 2015 Feb 26.
Major depressive disorder (MDD) is highly disabling and typically runs a recurrent course. Knowledge about prevention of relapse and recurrence is crucial to the long-term welfare of people who suffer from this disorder. This article provides an overview of the current evidence for the prevention of relapse and recurrence using psychological interventions. We first describe a conceptual framework to preventive interventions based on: acute treatment; continuation treatment, or; prevention strategies for patients in remission. In brief, cognitive-behavioral interventions, delivered during the acute phase, appear to have an enduring effect that protects patients against relapse and perhaps others from recurrence following treatment termination. Similarly, continuation treatment with either cognitive therapy or perhaps interpersonal psychotherapy appears to reduce risk for relapse and maintenance treatment appears to reduce risk for recurrence. Preventive relapse strategies like preventive cognitive therapy or mindfulness based cognitive therapy (MBCT) applied to patients in remission protects against subsequent relapse and perhaps recurrence. There is some preliminary evidence of specific mediation via changing the content or the process of cognition. Continuation CT and preventive interventions started after remission (CBT, MBCT) seem to have the largest differential effects for individuals that need them the most. Those who have the greatest risk for relapse and recurrence including patients with unstable remission, more previous episodes, potentially childhood trauma, early age of onset. These prescriptive indications, if confirmed in future research, may point the way to personalizing prevention strategies. Doing so, may maximize the efficiency with which they are applied and have the potential to target the mechanisms that appear to underlie these effects. This may help make this prevention strategies more efficacious.
重度抑郁症（MDD）高度致残，且通常反复发作。了解预防复发和再发的知识对于患有这种疾病的人的长期健康至关重要。本文概述了使用心理干预预防复发和再发的最新证据。我们首先根据以下几点描述了预防干预的概念框架：急性治疗；继续治疗；或缓解期患者的预防策略。简而言之，在急性阶段进行的认知行为干预似乎具有持久的效果，可以保护患者免受复发的影响，也许还可以防止其他人在治疗结束后复发。同样，继续进行认知疗法或人际心理治疗似乎可以降低复发的风险，维持治疗似乎可以降低复发的风险。应用于缓解期患者的预防性复发策略，如预防性认知疗法或正念认知疗法（MBCT），可预防随后的复发，也许还可以预防复发。有一些初步的证据表明，通过改变认知的内容或过程来进行特定的调解。对于最需要的个体，缓解后开始的继续 CT 和预防干预（CBT、MBCT）似乎具有最大的差异效果。那些复发和再发风险最高的人，包括缓解不稳定、有更多既往发作史、可能有童年创伤史、发病年龄较早的患者。如果在未来的研究中得到证实，这些预测性指标可能为个性化预防策略指明方向。这样做可能会最大限度地提高应用这些策略的效率，并有可能针对这些效果的潜在机制。这可能有助于使这些预防策略更有效。
