一项针对治疗抵抗性抑郁症成人的随机临床试验中， Radical Open 辩证行为疗法（RO DBT）的变化过程。

Processes of change in a randomized clinical trial of radically open dialectical behavior therapy (RO DBT) for adults with treatment-refractory depression.

机构信息

Department of Psychiatry.

Cognitive-Behavioral Therapy Center of Western North Carolina.

出版信息

J Consult Clin Psychol. 2023 Feb;91(2):71-81. doi: 10.1037/ccp0000795.

DOI:10.1037/ccp0000795

PMID:36913282

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11884404/

Abstract

OBJECTIVE

Radically open dialectical behavior therapy (RO DBT) is an empirically supported psychotherapy for treatment-refractory depression (TRD) that targets psychological inflexibility and interpersonal functioning within the context of maladaptive overcontrol. However, it is unknown whether change in these mechanistic processes is associated with decreased symptoms. This study tested whether change in psychological inflexibility and interpersonal functioning is associated with change in depressive symptoms in RO DBT.

METHOD

Adults with TRD from The Refractory Depression: Mechanisms and Efficacy of RO DBT (RefraMED) randomized controlled trial of RO DBT, n = 250; M (SD) age = 47.2 (11.5); 65% female; 90% White, were assigned to RO DBT or treatment as usual. Psychological inflexibility and interpersonal functioning were assessed at baseline, 3 (midtreatment), 7 (posttreatment), 12, and 18 months. Mediation analyses and latent growth curve modeling (LGCM) assessed whether change in psychological inflexibility and interpersonal functioning was associated with change in depressive symptoms.

RESULTS

The effect of RO DBT in decreasing depressive symptoms was mediated by changes in psychological inflexibility and interpersonal functioning at 3 (95% CI [-2.35, -0.15]; [-1.29, -0.04], respectively), 7 (95% CI [-2.80, -0.41]; [-3.39, -0.02]), and only psychological inflexibility at 18 (95% CI [-3.22, -0.62]) months. LGCM indicated only in RO DBT was a decrease in psychological inflexibility through 18 months associated with a decrease in depressive symptoms (B = 0.13, p < .001).

CONCLUSIONS

This supports RO DBT theory about targeting processes related to maladaptive overcontrol. Interpersonal functioning, and in particular, psychological flexibility, may be mechanisms that decrease depressive symptoms in RO DBT for TRD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

摘要

目的

激进开放辩证行为疗法（RO DBT）是一种针对治疗抵抗性抑郁症（TRD）的循证心理疗法，其针对的是适应不良过度控制背景下的心理灵活性和人际关系功能。然而，目前尚不清楚这些机制过程的变化是否与症状的减轻有关。本研究检验了 RO DBT 中心理灵活性和人际关系功能的变化是否与抑郁症状的变化有关。

方法

来自 RefraMED（RO DBT 的难治性抑郁症：机制和疗效）RO DBT 随机对照试验的 TRD 成年人，n = 250；M（SD）年龄= 47.2（11.5）；65%为女性；90%为白人，被分配到 RO DBT 或常规治疗。心理灵活性和人际关系功能在基线、3（中期治疗）、7（治疗后）、12 和 18 个月进行评估。中介分析和潜在增长曲线模型（LGCM）评估了心理灵活性和人际关系功能的变化是否与抑郁症状的变化有关。

结果

RO DBT 通过降低心理灵活性和人际关系功能来降低抑郁症状的效果在 3 个月（95%CI[-2.35，-0.15]；[-1.29，-0.04]）、7 个月（95%CI[-2.80，-0.41]；[-3.39，-0.02]）时具有中介作用，而仅在 18 个月时具有中介作用（95%CI[-3.22，-0.62]）。LGCM 表明，只有在 RO DBT 中，通过 18 个月降低心理灵活性与降低抑郁症状相关（B=0.13，p<0.001）。