Positive Affect Treatment for Depression and Anxiety: A Randomized Clinical Trial for a Core Feature of Anhedonia
Positive Affect Treatment for Depression and Anxiety: A Randomized Clinical Trial for a Core Feature of Anhedonia
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DOI：
10.1037/ccp0000396
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发表时间：
2019-05-01
影响因子：
5.9
通讯作者：
Rosenfield, David
中科院分区：
文献类型：
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作者：
Craske, Michelle G.;Meuret, Alicia E.;Rosenfield, David
目的：对活动失去乐趣或兴趣（即，快感缺乏）是自杀、治疗无反应和复发的危险因素。现存的治疗方法，侧重于减少负面影响有有限的影响，积极的影响（快感缺失的核心特征）。我们调查了一种旨在增加奖励敏感性的新干预措施是否比旨在降低威胁敏感性的认知行为治疗更有效，在临床上有严重抑郁或焦虑症状和功能障碍的个体中。方法：情感维度治疗试验是在洛杉矶和达拉斯的门诊治疗中心进行的一项2中心随机研究。96名患者被随机分配到15个每周一次的积极情绪治疗（PAT）或消极情绪治疗（NAT）。主要结局是从治疗前到6个月随访（6 MFU）的积极情感（积极和消极情感计划-积极）改善。次要结局是消极情感（积极和消极情感表-消极）、自杀意念和症状（抑郁焦虑压力量表）的改善。结果如下：PAT导致积极情感的改善更大，p = 0.009，d = 0.52，在6 MFU时更高的积极情感，p = 0.002，d = 0.67，比NAT。PAT的参与者还报告了较低的消极情感，p = 0.033，d = 0.52，和较低的抑郁症状。在6 MFU时，p = 0.035，d = 0.34，焦虑，p <0.018，d = 0.30，压力，p = 0.006，d = 0.43。最后，PAT中6 MFU时的自杀意念概率低于NAT（1.7% vs. 12.0%）。p <0.001。结论：与NAT相比，PAT在积极情感、抑郁方面表现出更好的结局（6 MFU）。焦虑、压力和自杀意念，对于具有这些结果的症状性预处理水平的患者。
Objective: Loss of pleasure or interest in activities (i.e., anhedonia) is a risk factor for suicidality, treatment nonresponse, and relapse. Extant treatments that focus on reducing negative affect have limited effects upon positive affect (a core feature of anhedonia). We investigated whether a novel intervention aimed at increasing reward sensitivity was more efficacious for positive affect than a cognitive-behavior treatment aimed at reducing threat sensitivity, in individuals with clinically severe symptoms of depression or anxiety, and functional impairment. Method: The Treatment for Affective Dimensions trial was offered in a 2-site randomized study at outpatient treatment centers in Los Angeles and Dallas. Ninety-six patients were randomized to 15 weekly, individual sessions of Positive Affect Treatment (PAT) or Negative Affect Treatment (NAT). The primary outcome was improvement in positive affect (Positive and Negative Affect Schedule-Positive) from pretreatment to 6-month follow-up (6MFU). Secondary outcomes were improvements in negative affect (Positive and Negative Affect Schedule-Negative), suicidal ideation, and symptoms (Depression Anxiety Stress Scales). Results: PAT resulted in greater improvements in positive affect, p = .009, d = .52, and higher positive affect at 6MFU, p = .002, d = .67, than NAT. Participants in PAT also reported lower negative affect, p = .033, d = .52, and lower symptoms of depression. p = .035, d = .34, anxiety, p < .018, d = .30, and stress, p = .006, d = .43 at 6MFU. Finally, probability of suicidal ideation at 6MFU was lower in PAT than NAT (1.7% vs. 12.0%). p < .001. Conclusions: Compared to NAT, PAT demonstrated better outcomes (at 6MFU) on positive affect, depression. anxiety, stress, and suicidal ideation, for patients with symptomatic pretreatment levels of these outcomes.