Fernie Bruce A, Kollmann Josianne, Brown Richard G
King's College London, Institute of Psychiatry, Department of Psychology, London, UK; CASCAID, South London & Maudsley NHS Foundation Trust, London, UK.
Philipps University Marburg, Institute of Psychology, Germany; King's College London, Institute of Psychiatry, Department of Psychology, London, UK.
J Psychosom Res. 2015 May;78(5):411-419. doi: 10.1016/j.jpsychores.2015.02.012. Epub 2015 Feb 26.
Chronic neurological conditions (CNCs) affect over one million people in the UK alone. Individuals with CNCs endure an increased prevalence of comorbid depression and anxiety. Poor mental health exacerbates the cost of the treatment and management of CNCs. CBT is recommended for the treatment of depression. However the application of CBT to individuals with CNCs may be limited by disease characteristics (e.g. mobility issues restricting therapy attendance and reducing engagement with behavioural activation, as well as difficulties challenging the veracity of disease-related negative thoughts that may reflect accurate appraisals). The objective of this review is to assess the clinical effectiveness of cognitive and behavioural interventions for depressive symptoms in individuals with non-acquired, medically explained CNCs.
Searches of The Cochrane Controlled Trials Register, PubMed, and PsychINFO were conducted.
All studies suggested that CBT is an effective treatment for depression comorbid to CNCs, however when CBT was compared to an active therapy control condition, between group differences were unstable.
CBT has promise for the treatment for depression in such conditions; however treatment protocols and outcome measures should be adapted for this population. Future trials should control for non-specific effects of therapy and, as much as possible, introduce blinding into methodologies.
仅在英国，慢性神经疾病（CNCs）就影响着超过100万人。患有慢性神经疾病的个体合并抑郁症和焦虑症的患病率更高。心理健康状况不佳会增加慢性神经疾病的治疗和管理成本。推荐采用认知行为疗法（CBT）治疗抑郁症。然而，将认知行为疗法应用于患有慢性神经疾病的个体时，可能会受到疾病特征的限制（例如，行动不便限制了治疗参与度，并减少了与行为激活的互动，以及难以质疑与疾病相关的消极想法的真实性，而这些想法可能反映了准确的评估）。本综述的目的是评估针对非后天性、有医学解释的慢性神经疾病患者抑郁症状的认知和行为干预的临床效果。
检索了Cochrane对照试验注册库、PubMed和PsychINFO。
所有研究均表明，认知行为疗法是治疗慢性神经疾病合并抑郁症的有效方法，然而，当将认知行为疗法与积极治疗对照条件进行比较时，组间差异不稳定。
认知行为疗法有望用于治疗此类疾病中的抑郁症；然而，治疗方案和结果测量应针对该人群进行调整。未来的试验应控制治疗的非特异性效应，并尽可能在方法中引入盲法。
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