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基于网络的正念认知疗法治疗有抑郁病史的成年人:一项随机对照试验方案。

Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial.

机构信息

University of South Carolina School of Medicine Greenville, Greenville, SC, United States.

Department of Health Sciences, College of Health Professions, Pace University, New York, NY, United States.

出版信息

JMIR Res Protoc. 2024 Jun 18;13:e53966. doi: 10.2196/53966.


DOI:10.2196/53966
PMID:38888958
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11220437/
Abstract

BACKGROUND: Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. OBJECTIVE: This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. METHODS: To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. RESULTS: This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. CONCLUSIONS: This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT's efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53966.

摘要

背景:抑郁症对公众健康构成重大威胁,其在美国的发病率呈上升趋势。基于正念的干预措施,如正念认知疗法(MBCT),是管理抑郁症状的有效方法,并且可能有助于加强现有努力来应对当前的疾病负担。然而,MBCT 的面对面团体形式存在费用、儿童保育需求和交通问题等障碍。通过网络提供的替代交付方式,如通过网络提供的 MBCT,可以研究其克服这些障碍的能力,同时通过足够的可行性和疗效来减轻抑郁症状。

目的:本研究方案旨在检验通过网络提供的 MBCT 治疗抑郁症的可行性和疗效。

方法:为了实现研究目标,将使用等待期对照设计实施两个阶段。共有 128 名符合条件的参与者将被随机分配到 8 周的 MBCT 干预组加常规治疗(MBCT+TAU;第 1 组)或 8 周的等待期对照组(第 2 组)。在第 I 阶段(8 周),第 1 组将完成干预,第 2 组将进行 TAU。在第 II 阶段(8 周),第 2 组将完成干预,第 1 组将继续进行 TAU,直到达到 8 周的随访。TAU 可能包括接受心理治疗、药物治疗或联合治疗。数据收集将在基线、8 周(第 1 组为干预后,第 2 组为干预前)和 16 周(第 1 组为随访,第 2 组为干预后)进行。主要结果将包括(1)当前、残留或慢性抑郁症状和(2)精神困扰。次要结果将包括感知压力和正念的各个方面。可行性将通过评估方案依从性、保留率、出勤率和参与度来衡量。最后,正念自我实践和执行功能技能的程度将作为干预结果的中介进行评估。

结果:本研究于 2022 年 12 月开始筛选和招募。第一队列的数据收集于 2023 年 1 月进行。截至 2023 年 11 月,共有 30 名参与者从接受筛选的 224 名参与者中入选。数据分析于 2024 年 2 月开始,结果大约于 2024 年 8 月公布。机构审查委员会于 2019 年 9 月 11 日批准。

结论:本试验将有助于检验通过网络提供的基于正念的干预措施,以改善当前、残留或慢性抑郁症状。它将(1)解决通过网络提供的 MBCT 的可行性;(2)提供 MBCT 降低抑郁症状和精神困扰的疗效证据;(3)评估 MBCT 对几个重要次要结果的影响。本研究的结果将进一步深入了解通过网络提供的 MBCT 与抑郁症状之间的因果关系途径,阐明未来更大规模设计的潜力。

试验注册:ClinicalTrials.gov NCT05347719;https://www.clinicaltrials.gov/ct2/show/NCT05347719。

国际注册报告标识符(IRRID):DERR1-10.2196/53966。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b46/11220437/a662a8061869/resprot_v13i1e53966_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b46/11220437/a4ab2c517fe3/resprot_v13i1e53966_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b46/11220437/a662a8061869/resprot_v13i1e53966_fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b46/11220437/a4ab2c517fe3/resprot_v13i1e53966_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4b46/11220437/a662a8061869/resprot_v13i1e53966_fig2.jpg

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引用本文的文献

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Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes.

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本文引用的文献

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