Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy Versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse
Treatment-Specific Changes in Decentering Following Mindfulness-Based Cognitive Therapy Versus Antidepressant Medication or Placebo for Prevention of Depressive Relapse
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DOI：
10.1037/a0027483
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发表时间：
2012-06-01
影响因子：
5.9
通讯作者：
Segal, Zindel V.
中科院分区：
文献类型：
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作者：
Bieling, Peter J.;Hawley, Lance L.;Segal, Zindel V.
目的：检验在正念认知疗法(MBCT)中获得的元认知心理技能是否也存在于接受预防抑郁症复发的药物治疗的患者中，以及这些技能是否中介MBCT的有效性。方法：这项研究嵌入了MBCT的随机疗效试验，首次检测了在6-8个月的抗抑郁药物治疗期间以及随后18个月的维持期内，患者停止用药并接受MBCT、继续服用抗抑郁药物或改用安慰剂期间注意力和重心的变化。总共有84名患者(平均年龄=44岁，其中58%是女性)被随机分配到这三种预防措施中的一种。除了症状变量，在研究的各个阶段还评估了专注力、沉思和分心的变化。结果：急性抑郁症的药物治疗与反省得分的降低和更广泛的经验增加有关。在维持阶段，只有接受MBCT的患者监测和观察思想和感觉的能力显著增强，这是通过体验问卷的更广泛的体验(P<；.01)和偏心(P<；.01)子量表和多伦多正念量表来衡量的。此外，更广泛的经验(P<；.05)和好奇心(P<；.01)的变化预测，在6个月的随访中，汉密尔顿抑郁评分较低。结论：在MBCT过程中，可以培养更强的偏心和好奇心，这可能是其有效性的基础。通过实践，患者可以学会对抗习惯性回避倾向，并以支持康复的方式调节烦躁不安的情绪。
Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Results: Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p < .01) and Decentering (p < .01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p < .05) and Curiosity (p < .01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. Conclusions: An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.