Vittengl Jeffrey R, Clark Lee Anna, Thase Michael E, Jarrett Robin B
Truman State University.
University of Notre Dame.
Int J Cogn Ther. 2014 Jan 9;7(3):255-271. doi: 10.1521/ijct.2014.7.3.251.
The cognitive model of depression posits that cognitive therapy's (CT) effect on depressive symptoms is mediated by changes in cognitive content (e.g., automatic negative thoughts dysfunctional attitudes, failure attributions). We tested improvement and normalization of cognitive content among outpatients ( = 523) with recurrent major depressive disorder treated with acute-phase CT (Jarrett & Thase, 2010; Jarrett et al., 2013). We also tested whether improvement in cognitive content accounted for subsequent changes in depressive symptoms and vice versa. Five measures of content improved substantively from pre- to post-CT (median = 0.96), and the proportions of patients scoring in "healthy" ranges increased (median 45% to 82%). Evidence for cognitive mediation of symptom reduction was limited (median = .06), as was evidence for symptom mediation of cognitive content improvement (median = .07). We discuss measurement and design issues relevant to detection of mediators and consider alternative theories of change.
抑郁症的认知模型假定，认知疗法（CT）对抑郁症状的影响是通过认知内容的变化（如自动消极思维、功能失调性态度、失败归因）来介导的。我们测试了接受急性期CT治疗的复发性重度抑郁症门诊患者（n = 523）认知内容的改善和正常化情况（贾勒特和塔斯，2010年；贾勒特等人，2013年）。我们还测试了认知内容的改善是否解释了随后抑郁症状的变化，反之亦然。从CT治疗前到治疗后，五项内容指标有实质性改善（中位数 = 0.96），得分在“健康”范围内的患者比例增加（中位数从45%增至82%）。症状减轻的认知介导证据有限（中位数 = 0.06），认知内容改善的症状介导证据也有限（中位数 = 0.07）。我们讨论了与中介物检测相关的测量和设计问题，并考虑了替代性的变化理论。
