CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
BMJ Ment Health. 2023 Feb;26(1). doi: 10.1136/bmjment-2022-300621.
Cognitive-behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment.
This study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices when quantifying change during treatment.
Symptom-specific effects of treatment were identified using moderated network modelling. This was a retrospective cohort study of 12 756 individuals who received CBT or CfD for depression in primary/community care psychological therapy services in England. Change was modelled several ways within the whole sample and a propensity score matched sample (n=3446).
CBT for depression directly affected excessive worry, trouble relaxing and apprehensive expectation and had a stronger influence on changes between suicidal ideation and concentration. CfD had a stronger direct influence on thoughts of being a failure and on the associated change between being an easily annoyed and apprehensive of expectation. There were inconsistencies when modelling change using the first and second appointments as the baseline. Residual score models produced more conservative findings than models using difference scores.
CfD and CBT for depression have differential effects on symptoms demonstrating specific mechanisms of change.
CBT was uniquely associated with changes in symptoms associated with anxiety and may be better suited to those with anxiety symptoms comorbid to their depression. When assessing change, the baseline should be the first therapy session, not the pretreatment assessment. Residual change scores should be preferred over difference score methods.
认知行为疗法（CBT）和抑郁症咨询（CfD）被推荐为抑郁症的一线治疗方法。虽然它们的改变方式不同，但对于治疗过程中这些方法对改变的影响知之甚少。
本研究旨在确定 CBT 和 CfD 是否针对不同的症状，并探讨在治疗过程中量化改变时建模选择的影响。
使用调节网络建模来确定治疗的症状特异性效应。这是一项在英格兰初级/社区保健心理治疗服务中接受 CBT 或 CfD 治疗抑郁症的 12756 名个体的回顾性队列研究。在整个样本和倾向评分匹配样本（n=3446）中，以多种方式对变化进行建模。
CBT 直接影响过度担忧、难以放松和忧虑的预期，对自杀意念和注意力之间的变化影响更大。CfD 对失败的想法和随之而来的容易生气和忧虑的预期变化有更强的直接影响。在使用第一次和第二次预约作为基线时，对变化进行建模存在不一致性。残余分数模型比使用差值分数的模型产生更保守的结果。
CfD 和 CBT 对抑郁症的症状有不同的影响，表现出特定的变化机制。
CBT 与与焦虑相关的症状变化具有独特的相关性，可能更适合那些伴有与抑郁共病的焦虑症状的患者。在评估变化时，基线应该是第一次治疗，而不是治疗前评估。应优先使用残余变化分数而不是差值分数方法。
