Mindfulness-Based Cognitive Therapy for Preventing Relapse in Recurrent Depression: A Randomized Dismantling Trial
Mindfulness-Based Cognitive Therapy for Preventing Relapse in Recurrent Depression: A Randomized Dismantling Trial
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DOI：
10.1037/a0035036
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发表时间：
2014-04-01
影响因子：
5.9
通讯作者：
Russell, Ian T.
中科院分区：
文献类型：
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作者：
Williams, J. Mark G.;Crane, Catherine;Russell, Ian T.
目的：我们比较了基于正念的认知疗法 (MBCT) 与认知心理教育 (CPE) 和常规治疗 (TAU) 在预防至少 3 次既往发作后目前处于缓解状态的重度抑郁症 (MDD) 复发方面的情况。方法：一项随机对照试验，其中 274 名参与者按 2:2:1 的比例分配至 MBCT 加 TAU、CPE 加 TAU 和单独 TAU，并对保留至随访的 255 名受试者（93%；MBCT = 99、CPE = 103、TAU = 53）的数据进行分析。 MBCT 是根据其出版的手册进行的，并经过修改以解决自杀认知； CPE 以 MBCT 为蓝本，但没有冥想训练。两种治疗均通过每周 8 节课程进行。结果：分配治疗对 12 个月随访期间 MDD 复发风险没有显着影响，MBCT 与 CPE 的风险比 = 0.88，95% CI [0.58，1.35]； MBCT 与 TAU = 0.69，95% CI [0.42，1.12]。然而，童年创伤的严重程度影响复发，增加 1 个标准差的风险比 = 1.26（95% CI [1.05, 1.50]），并且与分配的治疗显着相互作用。在严重程度高于中值的参与者中，MBCT 与 CPE 的风险比为 0.61，95% CI [0.34，1.09]，MBCT 与 TAU 的风险比为 0.43，95% CI [0.22，0.87]。对于那些低于中位严重程度的患者，治疗组之间不存在这种差异。结论：MBCT 为因童年创伤史而增加脆弱性的参与者提供了显着的预防复发的保护作用，但与积极控制治疗和常规护理相比，对整个复发性抑郁症患者组没有显示出显着优势。
Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2: 2: 1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.