Department of Psychiatry,The University of Texas Southwestern Medical Center, United States.
Truman State University, United States.
J Affect Disord. 2018 Jan 15;226:163-168. doi: 10.1016/j.jad.2017.09.045. Epub 2017 Sep 27.
The skills that patients learn in cognitive therapy (CT) and use thereafter may mediate improvement in depression during and after intervention.
We used a sequential, three-stage design: acute phase (523 outpatients received 12-14 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to continuation phases: C-CT, C-fluoxetine or C-pill placebo); and 24 months of longitudinal, post-treatment follow-up. Path analyses estimated mediation by skill measured by the Skills of Cognitive Therapy (SoCT: Patient and Observer [Therapist] versions).
Better SoCT scores predicted lower depressive symptoms both in CT and C-CT. In CT depressive symptoms did not predict subsequent changes in skills. During CT and C-CT, when averaged across patients and therapists, skills predicted subsequent decreases in depressive symptoms.
Generalization of findings may be limited by the trial's methodology.
Further rigorous investigation of the role of patient CT skills stands to increase understanding of mediators of change or engaged targets in psychosocial intervention.
患者在认知疗法（CT）中学到的技能并在干预期间和之后使用这些技能可能会对抑郁的改善起到中介作用。
我们采用了一个连续的三阶段设计：急性期（523 名门诊患者接受了 12-14 周的 CT）；8 个月的实验期（反应者中风险较高的患者被随机分配到延续阶段：C-CT、C-氟西汀或 C-安慰剂）；以及 24 个月的纵向治疗后随访。路径分析通过认知治疗技能（SoCT：患者和观察者[治疗师]版本）来衡量技能的中介作用。
SoCT 评分越高，CT 和 C-CT 中的抑郁症状越低。在 CT 中，抑郁症状并没有预测随后技能的变化。在 CT 和 C-CT 中，当平均考虑患者和治疗师时，技能预测了随后抑郁症状的降低。
研究结果的推广可能受到试验方法的限制。
进一步严格研究患者 CT 技能的作用，有助于增加对心理社会干预变化中介或参与目标的理解。
