ABSTRACT

Objective

Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules’ relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules.

Method

We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (M_age = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome.

Results

None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up.

Conclusions

Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up.

Abbreviations

CDI-2:F: Children’s Depression Inventory-2 Full-length version; CDI-2:S: Children’s Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.

中文翻译：

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CBT 成分和测序在青少年抑郁症预防中的相对有效性：整群随机微观试验

摘要

客观的

认知行为疗法（CBT）被分解为四个模块，每个模块三个疗程：认知重建（Think）、行为激活（Act）、解决问题（Solve）和放松（Relax）。我们调查了这些模块在预防青少年抑郁症方面的相对有效性，并检查了这些模块排序的变化。

方法

我们进行了一项具有四个平行条件的实用整群随机微观试验：(1) 思考-行动-放松-解决（n = 14 个聚类，n = 81 名参与者）；(2) 行动-思考-放松-解决（n = 13，n = 69）；(3) 解决-行动-思考-放松（n = 13，n = 77）；(4) 放松-解决-行动-思考（n = 12，n = 55）。样本由 282 名抑郁症状加重的荷兰青少年组成（M_年龄 = 13.8；55.7% 为女孩，92.9% 为荷兰人）。总共 52 个治疗组被随机分组​​。在基线、每个模块结束后以及 6 个月随访时进行评估，以抑郁症状作为主要结果。

结果

三个课程后，没有一个模块（思考、行动、解决、放松）与抑郁症状的显着减少相关，并且模块之间的有效性没有显着差异。除“放松-解决-行动-思考”序列外，所有模块序列均与干预后抑郁症状的显着减少相关。在 6 个月的随访中，所有序列均显示抑郁症状显着减轻。干预后和 6 个月随访时，序列之间的有效性没有显着差异。

结论

无论提供何种 CBT 技术，三个疗程的一个模块可能不足以减轻抑郁症状。CBT 的认知重建、行为激活、问题解决和放松的顺序似乎不会显着影响干预后或 6 个月随访的结果。

缩写

CDI-2:F：儿童抑郁量表-2全长版；CDI-2:S：儿童抑郁量表-2简版；STARr：解决、思考、行动、放松和重复。