Hawley Lance L, Padesky Christine A, Hollon Steven D, Mancuso Enza, Laposa Judith M, Brozina Karen, Segal Zindel V
Sunnybrook Health Sciences Centre, Frederick Thompson Anxiety Disorders Centre, and University of Toronto.
Center for Cognitive Therapy.
Behav Ther. 2017 Jan;48(1):29-44. doi: 10.1016/j.beth.2016.09.003. Epub 2016 Sep 23.
Cognitive-behavioral therapy (CBT) for depression is highly effective. An essential element of this therapy involves acquiring and utilizing CBT skills; however, it is unclear whether the type of CBT skill used is associated with differential symptom alleviation. Outpatients (N = 356) diagnosed with a primary mood disorder received 14 two-hour group sessions of CBT for depression, using the Mind Over Mood protocol. In each session, patients completed the Beck Depression Inventory and throughout the week they reported on their use of CBT skills: behavioral activation (BA), cognitive restructuring (CR), and core belief (CB) strategies. Bivariate latent difference score (LDS) longitudinal analyses were used to examine patterns of differential skill use and subsequent symptom change, and multigroup LDS analyses were used to determine whether longitudinal associations differed as a function of initial depression severity. Higher levels of BA use were associated with a greater subsequent decrease in depressive symptoms for patients with mild to moderate initial depression symptoms relative to those with severe symptoms. Higher levels of CR use were associated with a greater subsequent decrease in depressive symptoms, whereas higher levels of CB use were followed by a subsequent increase in depressive symptoms, regardless of initial severity. Results indicated that the type of CBT skill used is associated with differential patterns of subsequent symptom change. BA use was associated with differential subsequent change as a function of initial severity (patients with less severe depression symptoms demonstrated greater symptom improvement), whereas CR use was associated with symptom alleviation and CB use with an increase in subsequent symptoms as related to initial severity.
认知行为疗法（CBT）治疗抑郁症非常有效。这种疗法的一个关键要素是掌握和运用CBT技能；然而，尚不清楚所使用的CBT技能类型是否与不同的症状缓解情况相关。356名被诊断患有原发性情绪障碍的门诊患者使用“情绪之上的思维”方案接受了14次为时两小时的抑郁症CBT团体治疗。在每次治疗中，患者完成贝克抑郁量表，并且在整个星期内报告他们对CBT技能的使用情况：行为激活（BA）、认知重构（CR）和核心信念（CB）策略。使用双变量潜在差异分数（LDS）纵向分析来检验不同技能使用模式及随后的症状变化，使用多组LDS分析来确定纵向关联是否因初始抑郁严重程度而异。相对于重度症状患者，对于初始有轻度至中度抑郁症状的患者，较高水平的BA使用与随后更大程度的抑郁症状减轻相关。较高水平的CR使用与随后更大程度的抑郁症状减轻相关，而较高水平的CB使用之后是抑郁症状随后增加，无论初始严重程度如何。结果表明，所使用的CBT技能类型与随后症状变化的不同模式相关。BA使用与随后因初始严重程度而异的变化相关（抑郁症状较轻的患者症状改善更大），而CR使用与症状缓解相关，CB使用与随后与初始严重程度相关的症状增加相关。
