Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Clin Psychol Rev. 2022 Jul;95:102172. doi: 10.1016/j.cpr.2022.102172. Epub 2022 May 23.
Stage models encourage a longitudinal perspective on the care of those with major depression: supporting vigilance to the risk for stage progression and the selection of interventions to address that risk. A central goal for this article is to evaluate the role of cognitive-behavior therapy (CBT) in addressing stage progression in the treatment of major depression. We summarize the evidence supporting depression-focused CBT for: (1) preventing depression onset, (2) treating syndromal depression, (3) treating residual symptoms, (4) preventing relapse, and (5) addressing pharmacologic treatment resistance. In addition, consistent with the goal of aiding prevention and intervention development by refining mechanistic treatment targets, we evaluate the role of two specific risk-factors for stage progression: insomnia and rumination. These risk factors have a feed-forward relationship with stress, both being amplified by stress and amplifying the negative consequences of stress. Moreover, each of these risk factors predict depression stage transmissions across multiple stages, and both are modifiable with treatment. Accordingly, insomnia and rumination appear to serve as excellent mechanistic targets for the prevention of depression stage progression. These findings are discussed in relation to current limitations and future research directions for targeting these risk factors and furthering the effective treatment of depression.
支持警惕阶段进展的风险，并选择干预措施来应对该风险。本文的一个核心目标是评估认知行为疗法（CBT）在治疗重度抑郁症中应对阶段进展的作用。我们总结了支持以抑郁为重点的 CBT 的证据，包括：（1）预防抑郁发作，（2）治疗综合征性抑郁，（3）治疗残留症状，（4）预防复发，以及（5）解决药物治疗抵抗。此外，为了通过细化治疗靶点来帮助预防和干预的发展，我们评估了两个特定的与阶段进展相关的风险因素：失眠和反刍。这些风险因素与压力呈前馈关系，两者都被压力放大，并放大压力的负面影响。此外，这些风险因素中的每一个都可以预测多个阶段的抑郁阶段传播，并且都可以通过治疗来改变。因此，失眠和反刍似乎是预防抑郁阶段进展的极好的机制靶点。这些发现与针对这些风险因素和进一步有效治疗抑郁症的当前局限性和未来研究方向相关。
