Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
Br J Clin Psychol. 2019 Sep;58(3):245-259. doi: 10.1111/bjc.12213. Epub 2018 Dec 16.
The availability of treatment for depression needs to be improved. Among the barriers are the dearth of group programmes and the high demand of many programmes with regard to staff expertise. The Metacognitive Training for Depression (D-MCT) is a new, easy-to-administer, cognitive behaviour-based group intervention. In a previous 6-month trial, D-MCT was highly accepted by patients and efficacious compared to a control treatment. The aim of the current study was to examine whether the effects of the D-MCT can be sustained over 3.5 years.
Long-term follow-up of a randomized controlled trial.
A total of 84 patients with a confirmed diagnosis of unipolar depressive disorder were enrolled in a randomized, controlled, assessor-blind, parallel group trial comparing two interventions added to usual care: D-MCT and general health training (HT). Patients were reassessed 3.5 years after the interventions were terminated. Primary outcome was the Hamilton Depression Rating Scale. Self-assessed depressive symptom severity (BDI), dysfunctional cognitive (DAS) and metacognitive (MCQ) beliefs, self-esteem (RSE), and quality of life (WHOQOL-BREF) served as secondary outcomes.
Primary intention-to-treat analyses using analysis of covariance showed negative results, and only secondary post-hoc analyses utilizing latent growth modelling demonstrated superiority of D-MCT over HT with regard to the long-term course of depressive symptom severity and cognitive and metacognitive outcomes as well as physical and psychological quality of life.
Findings suggest that D-MCT may be a promising add-on treatment for unipolar depression that should be investigated in large multi-centre studies. Independent replications are needed.
Clinical implications: The current study shows tentative evidence that positive effects of the D-MCT reported at the 6-month follow-up assessment were sustained over 3.5 years. Potential positive effects regard severity of depression, dysfunctional cognitive, and metacognitive beliefs as well as quality of life. If positive results are replicated with less trained therapists, D-MCT offers the possibility of providing a simple and easy-to-administer CBT-based group treatment for depression with long lasting effects.
Sample size was small; a large-scale multi-centre trial would be desirable to gain high statistical power with an adequate sample size and to allow the investigation of possible allegiance effects. D-MCT was delivered as an add-on intervention and not as a stand-alone intervention.
需要改善抑郁症的治疗方法。其中的障碍包括缺乏团体方案以及许多方案对员工专业知识的高需求。认知行为治疗抑郁的元认知训练（D-MCT）是一种新的、易于管理的、基于认知行为的团体干预方法。在之前的 6 个月试验中，D-MCT 受到了患者的高度接受，并与对照治疗相比具有疗效。本研究的目的是检验 D-MCT 的效果是否可以持续 3.5 年以上。
一项随机对照试验的长期随访。
共纳入 84 例经确诊的单相抑郁障碍患者，进行一项随机、对照、评估者盲、平行组试验，比较两种附加于常规护理的干预措施：D-MCT 和一般健康训练（HT）。在干预结束 3.5 年后对患者进行重新评估。主要结局是汉密尔顿抑郁评定量表。自我评估的抑郁症状严重程度（BDI）、功能失调认知（DAS）和元认知（MCQ）信念、自尊（RSE）和生活质量（WHOQOL-BREF）作为次要结局。
使用协方差分析的主要意向治疗分析显示阴性结果，仅利用潜在增长模型的次要事后分析显示，D-MCT 在抑郁症状严重程度以及认知和元认知结局以及身体和心理生活质量的长期过程方面优于 HT。
研究结果表明，D-MCT 可能是单相抑郁的一种有前途的附加治疗方法，应在大型多中心研究中进行研究。需要进行独立的复制研究。
本研究表明，在 6 个月随访评估中报告的 D-MCT 的积极影响在 3.5 年以上持续存在，这是初步证据。可能的积极影响包括抑郁严重程度、功能失调认知和元认知信念以及生活质量。如果使用训练较少的治疗师进行积极结果的复制，D-MCT 为提供一种简单易行的基于认知行为的团体治疗抑郁症提供了可能性，且具有持久的效果。
样本量较小；需要进行一项大规模的多中心试验，以获得足够的样本量和高统计效能，并允许调查可能的效忠效应。D-MCT 作为附加干预措施而不是独立干预措施提供。
