Vittengl Jeffrey R, Clark Lee Anna, Thase Michael E, Jarrett Robin B
Department of Psychology, Truman State University, Kirksville, Missouri, USA.
Department of Psychology, University of Notre Dame, Notre Dame, Indiana, USA.
J Psychopathol Behav Assess. 2022 Jun;44(2):469-480. doi: 10.1007/s10862-021-09914-y. Epub 2021 Aug 17.
Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but how CT helps patients is incompletely understood. As a potential means to clarify CT mechanisms, we defined "symptom linkage density" (SLD) as a patient's mean time-lagged correlation among nine depressive symptoms across 13 weekly assessments. We hypothesized that patients with higher SLD during CT have better outcomes (treatment response, and fewer symptoms after response), and we explored whether SLD correlated with other possible CT processes (growth in social adjustment and CT skills).
Data were drawn from two clinical trials of CT for adult outpatients with recurrent MDD (primary sample = 475, replication sample = 146). In both samples, patients and clinicians completed measures of depressive symptoms and social adjustment repeatedly during CT. In the primary sample, patients and cognitive therapists rated patients' CT skills. After CT, responders were assessed for 32 (primary sample) or 24 (replication sample) additional months to measure long-term depression outcomes.
Higher SLD predicted increases in social adjustment (both samples) and CT skills (primary sample) during CT, CT response (both samples), and lower MDD severity for at least 2 years after CT response (both samples). Analyses controlled patient-level symptom means and variability to estimate SLD's incremental predictive validity.
These novel findings from two independent samples with longitudinal follow-up require further replication and extension. SLD may reflect or facilitate generalization of CT skills, improvement in social functioning, or other processes responsible for CT's shorter and longer term benefits.
急性期认知疗法（CT）是治疗重度抑郁症（MDD）的一种有效方法，但CT如何帮助患者尚不完全清楚。作为阐明CT机制的一种潜在手段，我们将“症状关联密度”（SLD）定义为患者在13次每周评估中9种抑郁症状之间的平均时间滞后相关性。我们假设在CT治疗期间SLD较高的患者有更好的治疗结果（治疗反应，反应后症状更少），并探讨了SLD是否与其他可能的CT过程（社会适应和CT技能的提高）相关。
数据来自两项针对复发性MDD成年门诊患者的CT临床试验（主要样本=475，复制样本=146）。在两个样本中，患者和临床医生在CT治疗期间反复完成抑郁症状和社会适应的测量。在主要样本中，患者和认知治疗师对患者的CT技能进行评分。CT治疗后，对缓解者进行32个月（主要样本）或24个月（复制样本）的额外评估，以测量长期抑郁结果。
较高的SLD预测了CT治疗期间社会适应（两个样本）和CT技能（主要样本）的提高、CT反应（两个样本），以及CT反应后至少2年MDD严重程度的降低（两个样本）。分析控制了患者水平的症状均值和变异性，以估计SLD的增量预测效度。
来自两个独立样本并进行纵向随访的这些新发现需要进一步重复和扩展。SLD可能反映或促进CT技能的泛化、社会功能的改善，或其他导致CT短期和长期益处的过程。
