Lerma Abel, Perez-Grovas Héctor, Bermudez Luis, Peralta-Pedrero María L, Robles-García Rebeca, Lerma Claudia
University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico.
Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico.
Psychol Psychother. 2017 Mar;90(1):105-123. doi: 10.1111/papt.12098. Epub 2016 Jul 20.
Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD.
For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI.
Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant).
At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety.
A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients.
A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
终末期肾病（ESRD）患者抑郁症的心理治疗主要针对重度抑郁患者。我们设计并测试了一种简短（5周）的认知行为干预（CBI），以减轻ESRD患者的轻度和中度抑郁及焦虑症状。
为进行本研究，采用单盲随机对照设计，比较接受血液透析治疗的ESRD患者接受和未接受CBI的情况。
对152名受试者（18 - 60岁，84名男性）进行抑郁和焦虑症状筛查。60名抑郁（贝克抑郁量表）和焦虑（贝克焦虑量表）轻度或中度评分的参与者（年龄41.8±14.7，29名男性）被随机分配到CBI组或对照组。CBI技术包括积极的自我强化、深呼吸、肌肉放松和认知重构。在基线、5周后（治疗结束时）和4周随访后评估抑郁、焦虑、生活质量（QoL）和认知扭曲评分。所有评分通过重复测量方差分析进行比较，并采用Bonferroni法调整的事后检验（p <.05被认为具有统计学意义）。
随访时，干预组的抑郁、焦虑和认知扭曲程度降低，生活质量提高，而对照组无变化。抑郁的临床效用为33%，焦虑为43%。
为期5周的简短CBI对减轻ESRD血液透析患者的轻度或中度抑郁和焦虑症状及改善生活质量有效。
一种简短、系统且结构化的认知行为干预（CBI）可减轻接受血液透析治疗的终末期肾病（ESRD）患者的焦虑和抑郁症状，并改善其生活质量。当识别出焦虑和抑郁症状但未进行心理治疗时，无法获得这些益处。这种CBI包括对与抑郁和焦虑症状相关的扭曲思维（完美主义、灾难化思维、消极自我标签和二分法思维）进行认知重构，这些思维可通过为ESRD患者设计的有效问卷进行评估。为本研究编写的手册结构合理且系统。它们对于支持护士、医生、社会工作者和心理学家等非专业卫生专业人员在CBI中的工作和参与可能具有价值，增加了在各种临床人群中进一步应用的可能性。如有需要，治疗手册和患者手册均提供西班牙语版本。
