Doyle Colleen, Bhar Sunil, Fearn Marcia, Ames David, Osborne Debra, You Emily, Gorelik Alex, Dunt David
National Ageing Research Institute, Melbourne, Victoria, Australia.
Australian Catholic University, Melbourne, Victoria, Australia.
Br J Health Psychol. 2017 Sep;22(3):542-556. doi: 10.1111/bjhp.12245. Epub 2017 May 22.
The main objectives of this pragmatic randomized controlled trial were to investigate the impact of cognitive behaviour therapy (CBT) and an active social control (befriending) on depression and anxiety symptoms in people with chronic obstructive pulmonary disease (COPD).
Eligible participants were randomly allocated to receive eight weekly telephone interventions of CBT (n = 54) or befriending (n = 56). Repeated-measures ANOVA was used to assess changes in scores and Cohen's d was used to assess effect sizes.
Significant improvement was observed in anxiety symptoms for the befriending group from baseline (T1) to post-intervention assessment (T2) and to 8-week follow-up assessment (T3), with a small to medium effect size (Cohen's d = 0.3). Significant improvement was noted in depression symptoms from T1 to T2 for both groups, but only the CBT group had a significant difference at T3, with a small to medium effect size (Cohen's d = 0.4). For secondary outcomes, there was a significant change in COPD symptoms from T1 to T2 for the befriending group; however, at T3 this change was no longer significant. Finally, there was a significant change in general self-efficacy for both groups between T1 and T2, and T1 and T3.
Cognitive behaviour therapy reduced depression symptoms but not anxiety. Befriending reduced depression symptoms in the short term and anxiety symptoms in both the short term and long term. Further research is needed to demonstrate non-inferiority of telephone delivery compared with other formats, and to understand the impact of befriending which has the potential to be a cost-effective support for people with COPD. Statement of contribution What is already known on this subject? Depression and anxiety are common comorbidities in people with chronic obstructive pulmonary disease. Mood disorders are not commonly routinely treated in people with chronic obstructive pulmonary disease. Telephone-administered CBT has been shown to be as effective as face-to-face CBT in reducing depression and anxiety. What does this study add? Telephone-administered CBT can reduce depression symptoms in people with COPD. Telephone-administered befriending can reduce anxiety and depression symptoms in people with COPD. People with COPD who have mood disorders would prefer to have CBT than befriending.
这项实用随机对照试验的主要目的是研究认知行为疗法（CBT）和积极社交对照（交友）对慢性阻塞性肺疾病（COPD）患者抑郁和焦虑症状的影响。
符合条件的参与者被随机分配接受为期八周的每周一次的CBT电话干预（n = 54）或交友干预（n = 56）。采用重复测量方差分析来评估得分变化，并用科恩d值来评估效应大小。
交友组从基线（T1）到干预后评估（T2）以及到8周随访评估（T3），焦虑症状有显著改善，效应大小为小到中等（科恩d = 0.3）。两组从T1到T2抑郁症状均有显著改善，但只有CBT组在T3时有显著差异，效应大小为小到中等（科恩d = 0.4）。对于次要结果，交友组从T1到T2 COPD症状有显著变化；然而，在T3时这种变化不再显著。最后，两组在T1和T2之间以及T1和T3之间一般自我效能感有显著变化。
认知行为疗法减轻了抑郁症状，但未减轻焦虑症状。交友在短期内减轻了抑郁症状，在短期和长期内均减轻了焦虑症状。需要进一步研究以证明电话干预与其他形式相比的非劣效性，并了解交友的影响，交友有可能成为对COPD患者具有成本效益的支持方式。贡献声明关于该主题已知的内容有哪些？抑郁和焦虑是慢性阻塞性肺疾病患者常见的共病。慢性阻塞性肺疾病患者的情绪障碍通常未得到常规治疗。电话实施的CBT已被证明在减轻抑郁和焦虑方面与面对面CBT一样有效。这项研究增加了什么？电话实施的CBT可减轻COPD患者的抑郁症状。电话实施的交友可减轻COPD患者的焦虑和抑郁症状。患有情绪障碍的COPD患者更喜欢接受CBT而非交友。
