记忆支持策略的连续介质支持抑郁症认知治疗：通过患者依从性和治疗技能提高治疗效果。
Serial Mediators of Memory Support Strategies Used With Cognitive Therapy for Depression: Improving Outcomes Through Patient Adherence and Treatment Skills.
机构信息
University of California, Berkeley.
University of California, Berkeley.
出版信息
Behav Ther. 2023 Jan;54(1):141-155. doi: 10.1016/j.beth.2022.07.012. Epub 2022 Aug 5.
Patient memory for treatment is poor. Memory support strategies can be integrated within evidence-based psychological treatments to improve patient memory for treatment, and thereby enhance patient outcomes. The present study evaluated possible mechanisms of these memory support strategies. Specifically, we tested whether therapist use of memory support strategies indirectly predicts improved patient outcomes via serial improvements in (a) patient adherence throughout treatment and (b) patient utilization and competency of treatment skills. Adults with major depressive disorder (N = 178, mean age = 37.93, 63% female, 17% Hispanic or Latino) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy-as-usual. Because therapists from both treatment groups used memory support strategies, data from conditions were combined. Blind assessments of depression severity and overall impairment were conducted before treatment, immediately posttreatment (POST), at 6-month follow-up (6FU), and at 12-month follow-up (12FU). Patient adherence to treatment was rated by therapists and averaged across treatment sessions. Patients completed measures of treatment mechanisms-namely, utilization and competency in cognitive therapy skills-at POST, 6FU, and 12FU. Results of serial mediation models indicated that more therapist use of memory support predicted lower depression severity at POST, 6FU, and 12FU indirectly and sequentially through (a) increased patient adherence during treatment and (b) more utilization and competency of Cognitive Therapy skills at POST, 6FU, and 12FU. The same patterns were found for serial mediation models predicting lower overall impairment at POST, 6FU, and 12FU. Together, boosting memory for treatment may represent a promising means to enhance pantreatment mechanisms (i.e., adherence and treatment skills) as well as patient outcomes.
患者对治疗的记忆很差。记忆支持策略可以整合到基于证据的心理治疗中，以改善患者对治疗的记忆，从而提高患者的治疗效果。本研究评估了这些记忆支持策略的可能机制。具体来说，我们测试了治疗师使用记忆支持策略是否通过治疗过程中（a）患者依从性的逐步提高和（b）患者对治疗技能的利用和掌握能力的逐步提高，从而间接预测患者预后的改善。患有重度抑郁症的成年人（N=178，平均年龄=37.93，63%为女性，17%为西班牙裔或拉丁裔）被随机分配到认知疗法加记忆支持干预或认知疗法常规治疗。由于来自两个治疗组的治疗师都使用了记忆支持策略，因此合并了这两个条件的数据。在治疗前、治疗结束时（POST）、6 个月随访（6FU）和 12 个月随访（12FU）进行了抑郁严重程度和总体损伤的盲评。治疗师对患者的治疗依从性进行了评分，并对整个治疗过程进行了评分。患者在 POST、6FU 和 12FU 时完成了认知治疗技能的利用和掌握能力等治疗机制的测量。序列中介模型的结果表明，治疗师更多地使用记忆支持策略可以预测患者在 POST、6FU 和 12FU 时的抑郁严重程度降低，这是通过（a）治疗期间患者依从性的提高和（b）POST、6FU 和 12FU 时认知治疗技能的利用和掌握能力的提高来间接和依次实现的。对于预测 POST、6FU 和 12FU 时总体损伤降低的序列中介模型也出现了相同的模式。总的来说，增强对治疗的记忆可能是一种很有前途的方法，可以增强治疗前机制（即依从性和治疗技能）以及患者的预后。
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