Background Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. Objectives This study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices when quantifying change during treatment. Methods Symptom-specific effects of treatment were identified using moderated network modelling. This was a retrospective cohort study of 12 756 individuals who received CBT or CfD for depression in primary/community care psychological therapy services in England. Change was modelled several ways within the whole sample and a propensity score matched sample (n=3446). Findings CBT for depression directly affected excessive worry, trouble relaxing and apprehensive expectation and had a stronger influence on changes between suicidal ideation and concentration. CfD had a stronger direct influence on thoughts of being a failure and on the associated change between being an easily annoyed and apprehensive of expectation. There were inconsistencies when modelling change using the first and second appointments as the baseline. Residual score models produced more conservative findings than models using difference scores. Conclusions CfD and CBT for depression have differential effects on symptoms demonstrating specific mechanisms of change. Clinical implications CBT was uniquely associated with changes in symptoms associated with anxiety and may be better suited to those with anxiety symptoms comorbid to their depression. When assessing change, the baseline should be the first therapy session, not the pretreatment assessment. Residual change scores should be preferred over difference score methods. Data are available on reasonable request. The raw data are not publicly available due to the containing information that could compromise participant privacy/consent. The raw data that support the findings of this study are available on request from JEJB subject to appropriate permissions from the custodians of the data restrictions apply to the availability of these data, which were used under license for the current study. The data were provided by the IAPT services for evaluation as part of a wider service improvement project conducted in accordance with the procedures of the host institution and the NHS Trusts which operate the IAPT services (project reference: 00519-IAPT).

中文翻译：

---

与认知行为疗法相比，抑郁症咨询的症状特异性效果

背景 认知行为疗法（CBT）和抑郁症咨询（CfD）是推荐的抑郁症一线治疗方法。虽然他们以不同的方式对待改变，但人们对这些方法对治疗期间改变的影响知之甚少。目的 本研究旨在确定 CBT 和 CfD 是否针对不同的症状，并探讨模型选择在量化治疗期间变化时的影响。方法使用调节网络模型确定治疗的症状特异性效果。这是一项回顾性队列研究，纳入了 12,756 名在英格兰初级/社区护理心理治疗服务中接受 CBT 或 CfD 治疗抑郁症的个体。在整个样本和倾向得分匹配样本 (n=3446) 中以多种方式对变化进行建模。研究发现，抑郁症认知行为治疗直接影响过度忧虑、难以放松和忧虑预期，并对自杀意念和注意力的变化有更大的影响。CfD 对失败的想法以及容易恼怒和对期望感到忧虑之间的相关变化有更强烈的直接影响。使用第一次和第二次约会作为基线对变更进行建模时存在不一致的情况。残差分数模型比使用差异分数的模型产生更保守的结果。结论 CfD 和 CBT 治疗抑郁症对症状有不同的影响，显示出特定的变化机制。临床意义 CBT 与焦虑相关症状的变化具有独特的相关性，可能更适合那些伴有抑郁症状的焦虑症状患者。评估变化时，基线应该是第一次治疗，而不是治疗前评估。残余变化分数应优先于差异分数方法。可根据合理要求提供数据。由于包含可能损害参与者隐私/同意的信息，原始数据不公开。支持本研究结果的原始数据可根据 JEJB 的要求提供，但须获得数据保管人的适当许可，这些数据的可用性适用于这些数据的可用性，这些数据是在当前研究的许可下使用的。这些数据由 IAPT 服务提供用于评估，作为更广泛的服务改进项目的一部分，该项目根据主办机构和运营 IAPT 服务的 NHS 信托的程序进行（项目编号：00519-IAPT）。