拆除认知行为疗法核心成分在预防青少年抑郁中的相对有效性：一项集群随机微试验方案。
Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial.
机构信息
Department of Public Mental Health, Trimbos-institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500, AS, Utrecht, The Netherlands.
Child and Adolescent Studies, Utrecht University, P.O. Box 80140, 3508, TC, Utrecht, The Netherlands.
出版信息
BMC Psychiatry. 2019 Jun 27;19(1):200. doi: 10.1186/s12888-019-2168-6.
BACKGROUND
Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of "prevention packages" consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR - BA - RE - PS, (2) BA - CR - RE - PS, (3) PS - GA - CR - RE and (4) RE - PS - BA - CR.
METHODS
We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated.
DISCUSSION
The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs.
TRIAL REGISTRATION
The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.
背景
青少年时期的抑郁障碍和亚临床抑郁症状都是一个主要的公共卫生关注点。因此，重要的是要在早期发现抑郁并进行预防性治疗。基于认知行为疗法（CBT）的预防已被证明是最有效的，但研究主要集中在由多个 CBT 组成部分组成的“预防套餐”的有效性上，而不是 CBT 组成部分的独特性上。本研究将评估 CBT 的四个核心组成部分（认知重构（CR）、行为激活（BA）、问题解决（PS）和放松（RE））的相对有效性。此外，还将评估这四个组成部分的四种不同序列的相对（成本）效益：（1）CR-BA-RE-PS，（2）BA-CR-RE-PS，（3）PS-GA-CR-RE 和（4）RE-PS-BA-CR。
方法
我们将进行一项非盲多地点集群随机预防微型试验，共有四个平行条件，包括四个序列。这四个组成部分的序列将提供给有抑郁症状升高的高中生群体。为每个 CBT 组成部分开发了一个三个疗程的模块。评估将在基线、每次 CBT 组成部分后、每次疗程前、干预后和 6 个月随访时进行。将探索性地评估潜在的调节因素和中介因素，以了解哪些（序列的）CBT 组成部分对谁最有效，以及如何通过中介来产生效果。
讨论
该研究的潜在价值在于深入了解四种最常用的 CBT 组成部分和四种不同序列的相对有效性，以及青少年抑郁预防中的可能调节因素和中介因素。这些知识可用于优化和个性化 CBT 方案。
试验注册
该研究于 2016 年 10 月 13 日在荷兰试验注册处（试验 NL5584/NTR6176）注册。
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