SMART 治疗青少年情绪问题的跨诊断认知行为治疗的长期疗效和变化轨迹。

Long-term effectiveness and trajectories of change after treatment with SMART, a transdiagnostic CBT for adolescents with emotional problems.

机构信息

Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.

Department of Child and Adolescent Psychiatry, Divisions of Child and Adolescent Health, University Hospital of North Norway, P.O. Box 19, 9038, Tromsø, Norway.

出版信息

BMC Psychol. 2022 Jul 5;10(1):167. doi: 10.1186/s40359-022-00872-y.

DOI:10.1186/s40359-022-00872-y

PMID:35791020

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9258229/

Abstract

BACKGROUND

There is a need for long-term effectiveness trials of transdiagnostic treatments. This study investigates the effectiveness and diagnosis-specific trajectories of change in adolescent patients attending SMART, a 6-week transdiagnostic CBT for anxiety and depression, with 6-month follow-up.

METHODS

A randomized controlled trial with waiting list control (WLC) was performed at three child and adolescent mental health outpatient services (CAMHS) in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% females) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to treatment or to WLC. Long-term follow-up (N = 83, baseline age = 15.57, 94% females) was performed 6 months after treatment completion (Mean = 7.1 months, SD = 2.5). Linear mixed model analysis was used to assess time by group effects in patients with no diagnosis, probable anxiety, depressive disorder, and combined anxiety and depressive disorder.

RESULTS

Almost one third (31%) obtained full recovery according to the inclusion criterium (SDQ emotional). There was highly significant change in all outcome variables. Effect sizes (ES) were largest for general functioning, measured with CGAS (ES: d = 2.19), and on emotional problems measured with SDQ (ES: d = 2.10), while CORE-17, BDI-II and CGAS all obtained ES's close to 1. There were no significant time by diagnostic group interactions for any outcomes, indicating similar trajectories of change, regardless of diagnostic group. Waiting 6 weeks for treatment had no significant impact on long-term treatment effects.

LIMITATIONS

Possible regression to the mean. Attrition from baseline to follow-up.

CONCLUSIONS

Six weeks of transdiagnostic treatment for adolescents with emotional problems showed highly significant change in emotional symptoms and functioning at 6-month follow-up. Patients with anxiety, depression, combined anxiety and depression, and emotional problems with no specific diagnoses, all had similar trajectories of change. Hence this transdiagnostic SMART treatment can be recommended for adolescent patients with symptoms within the broad spectrum of emotional problems.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02150265. First registered May 29, 2014.

摘要

背景

需要对跨诊断治疗进行长期有效性试验。本研究调查了参加 SMART 的青少年患者的有效性和特定诊断的变化轨迹，SMART 是一种为期 6 周的焦虑和抑郁的跨诊断认知行为疗法，并进行了 6 个月的随访。

方法

在挪威的三个儿童和青少年心理健康门诊服务机构（CAMHS）进行了一项随机对照试验，设有等待名单对照（WLC）。有情绪障碍子量表（SDQ）得分 6 或以上的转诊青少年（N=163，年龄=15.72，90.3%为女性）随机分配至治疗组或 WLC 组。在治疗完成后 6 个月（治疗完成时的平均年龄=15.57，94%为女性）进行长期随访（N=83）。采用线性混合模型分析评估无诊断、可能的焦虑、抑郁障碍和合并焦虑和抑郁障碍患者的时间与组间效应。

结果

根据纳入标准（SDQ 情绪），近三分之一（31%）的患者获得完全缓解。所有结局变量均有显著变化。CGAS 测量的一般功能（ES：d=2.19）和 SDQ 测量的情绪问题（ES：d=2.10）的效果最大，而 CORE-17、BDI-II 和 CGAS 的效果均接近 1。对于任何结果，均未发现时间与诊断组之间存在显著的相互作用，表明无论诊断组如何，变化轨迹相似。等待 6 周接受治疗对长期治疗效果没有显著影响。