Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Anna Freud National Centre for Children and Families, London, UK.
Psychol Med. 2020 Apr;50(6):1010-1019. doi: 10.1017/S0033291719000928. Epub 2019 May 14.
Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated.
147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion.
The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.
DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.
改善心理治疗服务（IAPT）为英格兰初级保健机构中出现的大多数重度抑郁症患者提供服务。心理动力学心理治疗是提供的心理治疗之一。动态人际治疗（DIT）是一种针对抑郁症的心理动力学和心理化治疗方法。该治疗大约在 5 个月内进行 16 次。DIT 与低强度治疗（LIT）的有效性，以及在 IAPT 环境中将患者随机分配到心理动力学或认知行为治疗（CBT）的可行性，都尚未得到证实。
在一项联合优势和可行性设计中，147 名患者按 3:2:1 的比例随机分配到 DIT（n = 73）、LIT（对照组；n = 54）或 CBT（n = 20）组，共四个 IAPT 治疗服务。符合重度抑郁症标准的患者在基线、治疗中期（3 个月）和治疗后（6 个月）使用汉密尔顿抑郁量表（HRSD-17）、贝克抑郁量表-II（BDI-II）和其他自我评估问卷进行评估。接受 DIT 的患者在完成治疗后 6 个月也进行了随访。
DIT 组在 6 个月的主要终点时 HRSD-17 评分明显低于 LIT 组（d = 0.70）。与 LIT 组（9%）相比，DIT 组中有更多患者（51%）在 HRSD-17 上表现出明显的临床改善。DIT 组和 CBT 组在大多数结果上表现出等效性。结果与 BDI-II 相似。DIT 在一系列次要结局上表现出获益。
在初级保健环境中实施的 DIT 优于 LIT，并可在未来的 RCT 中与 CBT 进行适当比较。
