基于正念的认知疗法对比双相情感障碍患者常规治疗：一项多中心随机对照试验。
Mindfulness-based cognitive therapy treatment as usual in people with bipolar disorder: A multicentre, randomised controlled trial.
作者信息
Hanssen Imke, Huijbers Marloes, Regeer Eline, Lochmann van Bennekom Marc, Stevens Anja, van Dijk Petra, Boere Elvira, Havermans Rob, Hoenders Rogier, Kupka Ralph, Speckens Anne E
机构信息
Department of Psychiatry, Radboud University Medical Center, Center for Mindfulness, Reinier Postlaan 4, 6526 GC, Nijmegen, the Netherlands.
Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands.
出版信息
Psychol Med. 2023 Oct;53(14):6678-6690. doi: 10.1017/S0033291723000090. Epub 2023 Mar 7.
BACKGROUND
Mindfulness-based cognitive therapy (MBCT) seems a promising intervention for bipolar disorder (BD), but there is a lack of randomised controlled trials (RCT) investigating this. The purpose of this multicentre, evaluator blinded RCT was to investigate the added value of MBCT to treatment as usual (TAU) in BD up to 15 months follow-up (NCT03507647).
METHODS
A total of 144 participants with BD type I and II were randomised to MBCT + TAU ( = 72) and TAU ( = 72). Primary outcome was current depressive symptoms. Secondary outcomes were current (hypo)manic and anxiety symptoms, recurrence rates, rumination, dampening of positive affect, functional impairment, mindfulness skills, self-compassion, and positive mental health. Potential moderators of treatment outcome were examined.
RESULTS
MBCT + TAU was not more efficacious than TAU in reducing current depressive symptoms at post-treatment (95% CI [-7.0 to 1.8], = 0.303, = 0.24) or follow-up (95% CI [-2.2 to 6.3], = 0.037, = 0.13). At post-treatment, MBCT + TAU was more effective than TAU in improving mindfulness skills. At follow-up, TAU was more effective than MBCT + TAU in reducing trait anxiety and improving mindfulness skills and positive mental health. Exploratory analysis revealed that participants with higher depressive symptoms and functional impairment at baseline benefitted more from MBCT + TAU than TAU.
CONCLUSIONS
In these participants with highly recurrent BD, MBCT may be a treatment option in addition to TAU for those who suffer from moderate to severe levels of depression and functional impairment.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03507647. Registered the 25 April 2018, https://www.clinicaltrials.gov/ct2/show/NCT01126827.
背景
基于正念的认知疗法（MBCT）似乎是双相情感障碍（BD）的一种有前景的干预措施，但缺乏对此进行研究的随机对照试验（RCT）。这项多中心、评估者盲法的RCT的目的是在长达15个月的随访中研究MBCT相对于常规治疗（TAU）在双相情感障碍中的附加价值（NCT03507647）。
方法
总共144名I型和II型双相情感障碍患者被随机分为MBCT + TAU组（n = 72）和TAU组（n = 72）。主要结局是当前的抑郁症状。次要结局包括当前的（轻）躁狂和焦虑症状、复发率、沉思、积极情绪的抑制、功能损害、正念技能、自我同情和积极心理健康。研究了治疗结局的潜在调节因素。
结果
在治疗后（95%CI[-7.0至1.8]，p = 0.303，d = 0.24）或随访时（95%CI[-2.2至6.3]，p = 0.037，d = 0.13），MBCT + TAU在减轻当前抑郁症状方面并不比TAU更有效。在治疗后，MBCT + TAU在提高正念技能方面比TAU更有效。在随访时，TAU在降低特质焦虑、提高正念技能和积极心理健康方面比MBCT + TAU更有效。探索性分析显示，基线时抑郁症状和功能损害较高的参与者从MBCT + TAU中比从TAU中获益更多。
结论
在这些高复发双相情感障碍患者中，对于那些患有中度至重度抑郁和功能损害的患者，MBCT可能是除TAU之外的一种治疗选择。
试验注册
ClinicalTrials.gov，NCT03507647。于2018年4月25日注册，https://www.clinicaltrials.gov/ct2/show/NCT01126827。
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