正念认知疗法联合抗抑郁药物治疗复发性抑郁的恢复：一项具有说明性案例研究的定性研究。
Recovery from recurrent depression with mindfulness-based cognitive therapy and antidepressants: a qualitative study with illustrative case studies.
机构信息
Department of Psychiatry, University of Oxford, Oxford, UK.
Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK.
出版信息
BMJ Open. 2020 Feb 18;10(2):e033892. doi: 10.1136/bmjopen-2019-033892.
OBJECTIVES
This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM).
DESIGN
A qualitative study embedded within a multicentre, single blind, randomised controlled trial (the PREVENT trial).
SETTING
Primary care urban and rural settings in the UK.
PARTICIPANTS
42 people who participated in the MBCT arm of the parent trial were purposively sampled to represent a range of recovery journeys.
INTERVENTIONS
MBCT involves eight weekly group sessions, with four refresher sessions offered in the year following the end of the programme. It was adapted to offer bespoke support around ADM tapering and discontinuation.
METHODS
Written feedback and structured in-depth interviews were collected in the 2 years after participants undertook MBCT. Data were analysed using thematic analysis and case studies constructed to illustrate the findings.
RESULTS
People with recurrent depression have unique recovery journeys that shape and are shaped by their pharmacological and psychological treatment choices. Their journeys typically include several over-arching themes: (1) beliefs about the causes of depression, both biological and psychosocial; (2) personal agency, including expectations about their role in recovery and treatment; (3) acceptance, both of depression itself and the recovery journey; (4) quality of life; (5) experiences and perspectives on ADM and ADM tapering-discontinuation; and (6) the role of general practitioners, both positive and negative.
CONCLUSIONS
People with recurrent depression describe unique, complex recovery journeys shaped by their experiences of depression, treatment and interactions with health professionals. Understanding how several themes coalesce for each individual can both support their recovery and treatment choices as well as health professionals in providing more accessible, collaborative, individualised and empowering care.
TRIAL REGISTRATION NUMBER
Clinical trial number ISRCTN26666654; post results.
目的
本研究旨在描述参加预防复发性抑郁的心理社会方案（正念认知疗法（MBCT））的患者的康复历程，该方案旨在教授预防抑郁复发的技能，同时维持抗抑郁药物（ADM）治疗。
设计
一项嵌入多中心、单盲、随机对照试验（PREVENT 试验）的定性研究。
设置
英国的城市和农村初级保健环境。
参与者
从参加母试验 MBCT 组的 42 名患者中进行有目的抽样，以代表各种康复历程。
干预措施
MBCT 包括八次每周小组会议，在方案结束后的一年中提供四次复习课程。它经过改编，为 ADM 逐渐减少和停药提供了定制支持。
方法
在参与者完成 MBCT 后的 2 年内收集了书面反馈和结构化深入访谈。使用主题分析和案例研究来分析数据，以说明研究结果。
结果
复发性抑郁症患者的康复历程独特，塑造并受其药物和心理治疗选择的影响。他们的康复历程通常包括几个总体主题：（1）对抑郁的生物学和心理社会原因的信念；（2）个人能动性，包括对自己在康复和治疗中的角色的期望；（3）接受，包括对抑郁本身和康复历程的接受；（4）生活质量；（5）对 ADM 和 ADM 逐渐减少-停药的经验和看法；（6）全科医生的作用，包括积极和消极的方面。
结论
复发性抑郁症患者描述了独特而复杂的康复历程，这些历程受他们的抑郁经历、治疗和与卫生专业人员的互动影响。了解每个个体的几个主题是如何融合的，可以既支持他们的康复和治疗选择，也支持卫生专业人员提供更易获得、协作、个体化和赋权的护理。
试验注册号
临床试验编号 ISRCTN26666654；发表结果。
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