Murphy G E, Carney R M, Knesevich M A, Wetzel R D, Whitworth P
Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110, USA.
Psychol Rep. 1995 Oct;77(2):403-20. doi: 10.2466/pr0.1995.77.2.403.
Outcomes of seven treatment trials comparing cognitive behavioral therapy to treatment with tricyclic antidepressant medication in major depressive disorder have been quite similar to one another. This led us to question whether treatment outcome in time-limited studies reflected a unique effect of cognitive behavioral therapy. To test the uniqueness hypothesis, relaxation training, a nonpharmacologic, noncognitive treatment, was chosen as a comparison for cognitive behavioral therapy as well as drug therapy. Treatment duration was 16 weeks. The sample of 37 patients treated for major depressive disorder was less depressed than those previously studied. For both cognitive behavioral therapy and relaxation training, outcome of depression was superior to that of tricyclic antidepressant medication by endpoint analysis. The posttreatment scores on the Beck Depression Inventory of 82% of the group receiving cognitive behavioral therapy improved to a Beck Depression Inventory score < or = 9 which was not significantly greater than that for the group receiving relaxation training (73%), so a unique effect was not demonstrated for cognitive behavioral therapy. The outcome for tricyclic antidepressant medication (29% improved to criteria) was significantly worse than that for cognitive behavioral therapy. The patient's pretreatment initial expectancy was not predictive.
七项关于重度抑郁症的治疗试验结果显示，将认知行为疗法与三环类抗抑郁药物治疗进行比较，二者结果颇为相似。这使我们质疑，限时研究中的治疗结果是否反映了认知行为疗法的独特效果。为检验这一独特性假设，我们选择了放松训练作为认知行为疗法和药物疗法的对照，放松训练是一种非药物、非认知的治疗方法。治疗时长为16周。接受重度抑郁症治疗的37名患者样本，其抑郁程度低于之前研究的患者。通过终点分析，认知行为疗法和放松训练在抑郁症治疗结果方面均优于三环类抗抑郁药物。接受认知行为疗法的组中，82%的患者治疗后贝克抑郁量表得分改善至贝克抑郁量表得分≤9，这一比例并不显著高于接受放松训练的组（73%），因此未证明认知行为疗法具有独特效果。三环类抗抑郁药物的治疗结果（29%改善至标准）明显比认知行为疗法差。患者治疗前的初始预期并无预测作用。
