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A comparison of the effects of sudden gains and depression spikes on short- and long-term depressive symptoms in a randomized controlled trial of behavioral activation and cognitive behavioural therapy.
Journal of Consulting and Clinical Psychology ( IF 7.156 ) Pub Date : 2021-12-01 , DOI: 10.1037/ccp0000577
Heather A O'Mahen 1 , Adele Hayes 2 , Claire Harries 3 , Asha Ladwa 1 , Mohammod Mostazir 4 , David Ekers 5 , Dean McMillan 6 , David Richards 7 , Kimberly Wright 1
Affiliation  

OBJECTIVE The aim of this study was to examine the effects of sudden gains and depression spikes in a randomized controlled trial of cognitive behavioral therapy (CBT) and behavioral activation (BA) for depression (COBRA trial). METHOD This is a secondary analysis of 300 adults with major depressive disorder (MDD) who received CBT (n = 156) or BA (n = 144) (Richards et al., 2016). The Patient Health Questionnaire (PHQ-9) and Structured Clinical Interview Schedule (SCID) were used to measure depression symptoms at 6-, 12-, and 18-month follow-up. RESULTS One-hundred and ten (37%) individuals experienced sudden gains, and 77 (26%) experienced depression spikes. There were no differences in rates of gains or spikes between treatments. Individuals with sudden gains had lower PHQ-9 scores across follow-up and were less likely to meet SCID criteria than those without a sudden gain. Generalized estimating equation (GEE) models demonstrated that individuals who had a sudden gain and were in CBT had lower PHQ-9 scores at 6 and 18 months than those in BA. Conversely, individuals who had a depression spike and were in CBT had higher PHQ-9 scores across follow-up compared to those without a depression spike and also a greater chance of meeting SCID criteria for MDD at 18 months than those who received BA. CONCLUSIONS The short- and long-term impact of discontinuous change varied by type of treatment package. Identifying strategies within treatment packages and client processes that are associated with gains and spikes may help to inform treatment planning and clinical decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译:

在行为激活和认知行为疗法的随机对照试验中,比较突然获得和抑郁峰值对短期和长期抑郁症状的影响。

目的 本研究的目的是在认知行为疗法 (CBT) 和抑郁行为激活 (BA) 的随机对照试验(COBRA 试验)中检查突然获得和抑郁峰值的影响。方法 这是对接受 CBT (n = 156) 或 BA (n = 144) 的 300 名患有重度抑郁症 (MDD) 的成年人的二次分析(Richards 等人,2016 年)。患者健康问卷 (PHQ-9) 和结构化临床访谈时间表 (SCID) 用于测量 6、12 和 18 个月随访时的抑郁症状。结果 一百零十 (37%) 人经历了突然的收获,77 人 (26%) 经历了抑郁症高峰。治疗之间的增益率或峰值没有差异。突然获得的个体在随访期间的 PHQ-9 分数较低,并且与没有突然获得的人相比,满足 SCID 标准的可能性更小。广义估计方程 (GEE) 模型表明,在 6 个月和 18 个月时突然获得并参加 CBT 的个体的 PHQ-9 分数低于 BA 的个体。相反,与没有抑郁症高峰的人相比,抑郁症高峰并接受 CBT 的个体在随访期间的 PHQ-9 分数更高,并且在 18 个月时符合 MDD 的 SCID 标准的机会也比接受 BA 的人更大。结论 不连续变化的短期和长期影响因治疗方案的类型而异。识别与收益和峰值相关的治疗方案和客户流程中的策略可能有助于为治疗计划和临床决策提供信息。
更新日期:2021-12-01
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