Elkin I, Shea M T, Watkins J T, Imber S D, Sotsky S M, Collins J F, Glass D R, Pilkonis P A, Leber W R, Docherty J P
Mood, Anxiety and Personality Disorders Research Branch, National Institute of Mental Health, Bethesda, MD.
Arch Gen Psychiatry. 1989 Nov;46(11):971-82; discussion 983. doi: 10.1001/archpsyc.1989.01810110013002.
We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
我们调查了两种短程心理治疗方法，即人际心理治疗和认知行为治疗，用于治疗依据研究诊断标准确诊的重度抑郁症门诊患者的有效性。250名患者被随机分配至四种为期16周的治疗方案之一：人际心理治疗、认知行为治疗、盐酸丙咪嗪加临床管理（作为标准对照治疗）以及安慰剂加临床管理。在治疗过程中，所有治疗组的患者抑郁症状均显著减轻，功能状况也有所改善。治疗结束时，各治疗方案呈现出一致的排序，丙咪嗪加临床管理总体效果最佳，安慰剂加临床管理最差，两种心理治疗方案效果居中，但总体更接近丙咪嗪加临床管理。在不考虑疾病初始严重程度的全样本分析（主要分析）中，没有证据表明两种心理治疗方法中的一种比另一种更有效，也没有证据表明任何一种心理治疗方法明显不如标准对照治疗丙咪嗪加临床管理有效。将每种心理治疗方法与安慰剂加临床管理方案进行比较，人际心理治疗有有限的特定有效性证据，而认知行为治疗则没有。与安慰剂加临床管理相比，人际心理治疗和丙咪嗪加临床管理均有更高的康复率。然而，在主要分析中，四种治疗方案在平均得分上的有效性几乎没有显著差异。次要分析将患者按抑郁症状和功能损害的初始严重程度进行二分，这有助于解释主要分析中相对缺乏显著结果的原因。仅在抑郁更严重且功能受损的患者亚组中，治疗方案之间存在显著差异；在此，有一些证据表明人际心理治疗对这些患者有效，且有强有力的证据表明丙咪嗪加临床管理有效。相比之下，对于抑郁程度较轻且功能受损的患者，包括安慰剂加临床管理在内的各治疗方案之间没有显著差异。
