Robinson P, Bush T, Von Korff M, Katon W, Lin E, Simon G E, Walker E
Mental Health Service, University of Washington, Seattle, USA.
J Fam Pract. 1995 Apr;40(4):352-7.
Although researchers are paying more attention to the treatment of depression in the primary care setting, little is known about the nature of psychotherapeutic interactions that occur between primary care physicians and their patients in the context of a visit for depression. In recent years, brief cognitive behavioral therapy has been demonstrated to be efficacious, and the public has become more familiar with these techniques through media exposure and self-help books.
Depressed primary care patients were surveyed regarding the extent to which cognitive behavioral (CB) techniques were suggested during the primary care visit in which antidepressant medication was initially prescribed. One hundred fifty-five patients completed responses to phone surveys 1 month and 4 months after the visit. Patients were also surveyed regarding the recommendation of counseling by the primary care physician.
The majority of patients (61%) reported that their physician advised them to identify activities they were already doing that helped them feel better. Physician recommendations regarding planning pleasurable activities, problem solving, challenging depressive thoughts, and planning activities that boost confidence were reported by 22% to 40% of study patients. Older patients reported fewer interactions about CB strategies. Primary care physicians' suggestion of CB strategies was associated with both patient use of CB strategies in the months following the visit and better adherence to recommended medication therapy during the first month of treatment.
Many patients seem to recognize the occurrence of psychotherapeutic interactions during visits to their primary care physician in which an antidepressant medication was prescribed, and patients' recognition of these interactions is associated with increased adherence to the recommended course of antidepressant prescriptions.
尽管研究人员越来越关注基层医疗环境中抑郁症的治疗，但对于基层医疗医生与其患者在抑郁症就诊过程中发生的心理治疗互动的性质知之甚少。近年来，简短认知行为疗法已被证明是有效的，并且公众通过媒体曝光和自助书籍对这些技术也越来越熟悉。
对患有抑郁症的基层医疗患者进行调查，了解在首次开具抗抑郁药物的基层医疗就诊期间，认知行为（CB）技术被建议的程度。155名患者在就诊后1个月和4个月完成了电话调查回复。患者还被调查了基层医疗医生对咨询的建议。
大多数患者（61%）报告称，他们的医生建议他们识别自己已经在进行的有助于感觉更好的活动。22%至40%的研究患者报告称，医生建议进行愉快活动规划、解决问题、挑战抑郁思维以及规划增强信心的活动。老年患者报告的关于CB策略的互动较少。基层医疗医生对CB策略的建议与患者在就诊后几个月对CB策略的使用以及治疗第一个月对推荐药物治疗的更好依从性均相关。
许多患者似乎认识到在开具抗抑郁药物的基层医疗就诊过程中发生了心理治疗互动，并且患者对这些互动的认识与抗抑郁药物处方推荐疗程的依从性增加相关。
