Malkomsen Anders, Wilberg Theresa, Bull-Hansen Bente, Dammen Toril, Evensen Julie Horgen, Hummelen Benjamin, Løvgren André, Osnes Kåre, Ulberg Randi, Røssberg Jan Ivar
Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Psychiatry. 2025 Feb 11;25(1):113. doi: 10.1186/s12888-025-06544-6.
More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation).
One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12).
No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated.
These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment.
Clinical Trial gov. Identifier: NCT03022071. Date of registration: 2016-11-14.
需要更多关于认知行为疗法（CBT）和短期心理动力心理治疗（STPP）对重度抑郁症（MDD）有效性且偏倚风险较低的研究。本研究比较了CBT和STPP的治疗结果，并使用广泛的纳入标准（例如使用抗抑郁药或有强烈自杀意念的参与者），重点从效应量、可靠变化、脱落率和缓解率方面检验了每种治疗方法的改善情况。
100名患者被随机分配到CBT组或STPP组。所有患者要么接受CBT组的16次每周一次的治疗，随后3次每月一次的强化治疗，要么接受STPP组的28次每周一次的治疗。主要结局指标为汉密尔顿抑郁量表（HDRS）和贝克抑郁量表第二版（BDI-II）。次要结局指标为工作与社会适应量表（WSAS）、广泛性焦虑障碍量表-7（GAD-7）、功能总体评定量表（GAF）和简明健康调查-12（SF-12）。
在任何一项指标上，两个治疗组之间均未发现显著的结果差异。主要结局指标的组内效应较大（>0.8），次要结局指标的组内效应为中等至较大。根据可靠变化指数（RCI），79%的患者在HDRS上有可靠改善，76%的患者在BDI-II上有改善，而分别有6%和10%的患者可靠地恶化。
这些发现支持了以下假设，即CBT和STPP对精神科门诊的抑郁症患者是同样有效的治疗方法。此外，它们加强了CBT和STPP在这些环境中有效性的证据，同时也强调并非所有抑郁症患者都对短期治疗有反应。
Clinical Trial gov。标识符：NCT03022071。注册日期：2016年11月14日。
