National Center for PTSD, Veterans Affairs Palo Alto Health Care System, USA; Department of Psychology, University of California, Berkeley, USA.
National Center for PTSD, Veterans Affairs Palo Alto Health Care System, USA.
Behav Res Ther. 2015 Nov;74:25-31. doi: 10.1016/j.brat.2015.08.012. Epub 2015 Aug 31.
OBJECTIVE: This paper examines the effects of Acceptance and Commitment Therapy for depression (ACT-D), and the specific effects of experiential acceptance and mindfulness, in reducing suicidal ideation (SI) and depression among Veterans. METHOD: Patients included 981 Veterans, 76% male, mean age 50.5 years. Depression severity and SI were assessed using the BDI-II. Experiential acceptance and mindfulness were measured with the Acceptance and Action Questionnaire-II (AAQ-II) and the Five Facet Mindfulness Questionnaire, respectively. RESULTS: Of the 981 patients, 647 (66.0%) completed 10 or more sessions or finished early due to symptom relief. For Veterans with SI at baseline, mean BDI-II score decreased from 33.5 to 22.9. For Veterans with no SI at baseline, mean BDI-II score decreased from 26.3 to 15.9. Mixed models with repeated measurement indicated a significant reduction in depression severity from baseline to final assessment (b = -10.52, p < .001). After adjusting for experiential acceptance and mindfulness, patients with SI at baseline demonstrated significantly greater improvement in depression severity during ACT-D treatment, relative to patients with no SI at baseline (b = -2.81, p = .001). Furthermore, increases in experiential acceptance and mindfulness scores across time were associated with a reduction in depression severity across time (b = -0.44, p < .001 and b = -0.09, p < .001, respectfully), and the attenuating effect of mindfulness on depression severity increased across time (b = -0.05, p = .042). Increases in experiential acceptance scores across time were associated with lower odds of SI across time (odds ratio = 0.97, 95% CI [0.95, 0.99], p = .016) and the attenuating effect of experiential acceptance on SI increased across time (odds ratio = 0.96, 95% CI [0.92, 0.99], p = .023). Overall the number of patients with no SI increased from 44.5% at baseline to 65% at follow-up. CONCLUSIONS: Veterans receiving ACT-D demonstrated decreased depression severity and decreased odds of SI during treatment. Increases in experiential acceptance and mindfulness scores were associated with reduction in depression severity across time and increases in experiential acceptance scores were associated with reductions in SI across time.
目的：本研究旨在探讨接受与承诺疗法（ACT）对抑郁的疗效，以及体验式接纳和正念对降低退伍军人自杀意念（SI）和抑郁的具体作用。
方法：研究纳入了 981 名退伍军人，其中 76%为男性，平均年龄为 50.5 岁。使用贝克抑郁自评量表第二版（BDI-II）评估抑郁严重程度和自杀意念，使用接纳与行动问卷第二版（AAQ-II）和五因素正念量表分别评估体验式接纳和正念。
结果：981 名患者中，647 名（66.0%）完成了 10 次或更多次治疗或因症状缓解而提前结束治疗。基线时有自杀意念的退伍军人，BDI-II 评分从 33.5 降至 22.9。基线时无自杀意念的退伍军人，BDI-II 评分从 26.3 降至 15.9。重复测量混合模型显示，从基线到最终评估，抑郁严重程度显著降低（b=-10.52，p<.001）。调整体验式接纳和正念后，基线时有自杀意念的患者在 ACT-D 治疗中抑郁严重程度的改善显著大于基线时无自杀意念的患者（b=-2.81，p=.001）。此外，体验式接纳和正念得分随时间的增加与抑郁严重程度随时间的降低相关（b=-0.44，p<.001 和 b=-0.09，p<.001），而正念对抑郁严重程度的衰减作用随时间的增加而增强（b=-0.05，p=.042）。体验式接纳得分随时间的增加与自杀意念随时间的降低相关（比值比=0.97，95%可信区间[0.95，0.99]，p=.016），体验式接纳对自杀意念的衰减作用随时间的增加而增强（比值比=0.96，95%可信区间[0.92，0.99]，p=.023）。总的来说，基线时无自杀意念的患者比例从 44.5%增加到随访时的 65%。
结论：接受 ACT-D 治疗的退伍军人在治疗过程中抑郁严重程度降低，自杀意念减少。体验式接纳和正念得分的增加与抑郁严重程度随时间的降低相关，体验式接纳得分的增加与自杀意念随时间的降低相关。
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