The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA)
The development of an RDoC-based treatment program for adolescent depression: "Training for Awareness, Resilience, and Action" (TARA)
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DOI：
10.3389/fnhum.2014.00630
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发表时间：
2014-08-19
影响因子：
2.9
通讯作者：
Yang, Tony T.
中科院分区：
文献类型：
--
作者：
Blom, Eva Henje;Duncan, Larissa G.;Yang, Tony T.
重度抑郁症（MDD）是目前世界范围内导致残疾的主要原因之一。青春期是抑郁症发作的脆弱时期，MDD影响所有青年的8-20%。传统的治疗方法并不足以有效地减缓青少年抑郁症日益增加的患病率。因此，我们提出了一种治疗青少年抑郁症的新模式--意识、复原力和行动训练（塔拉）--该模式基于当前对发育和抑郁神经生物学的理解。塔拉模型与美国国家心理健康研究所的研究领域标准（RDoC）保持一致。在这篇文章中，我们首先讨论RDoC与青少年抑郁症的相关性。其次，我们确定了主要的RDoC域的功能参与青少年抑郁症，并组织他们的方式，优先考虑域被认为是驱动的精神病理学。第三，我们选择治疗训练策略塔拉根据目前的科学证据的有效性的优先领域的功能，以最大限度地提高时间，资源和可行性。塔拉模型考虑了青少年自上而下的认知控制的发展限制，并促进自下而上的策略，如迷走神经传入，以减少边缘系统过度激活及其次级效应。该计划已被告知基于正念的治疗和瑜伽，以及现代心理治疗技术。治疗计划是半手动的，渐进的，并应用于一个基于模块的方法，设计用于一组设置，每周进行一次会议，持续12周。我们希望这项工作可以为青少年抑郁症的新型和更有效的治疗策略奠定基础，并扩大关于如何应对这一挑战的讨论。
Major depressive disorder (MDD) is one of the current leading causes of disability worldwide. Adolescence is a vulnerable period for the onset of depression, with MDD affecting 8-20% of all youth. Traditional treatment methods have not been sufficiently effective to slow the increasing prevalence of adolescent depression. We therefore propose a new model for the treatment of adolescent depression - Training for Awareness, Resilience, and Action (TARA) - that is based on current understanding of developmental and depression neurobiology. The TARA model is aligned with the Research Domain Criteria (RDoC) of the National Institute of Mental Health. In this article, we first address the relevance of RDoC to adolescent depression. Second, we identify the major RDoC domains of function involved in adolescent depression and organize them in a way that gives priority to domains thought to be driving the psychopathology. Third, we select therapeutic training strategies for TARA based on current scientific evidence of efficacy for the prioritized domains of function in a manner that maximizes time, resources, and feasibility. The TARA model takes into consideration the developmental limitation in top-down cognitive control in adolescence and promotes bottom-up strategies such as vagal afference to decrease limbic hyperactivation and its secondary effects. The program has been informed by mindfulness-based therapy and yoga, as well as modern psychotherapeutic techniques. The treatment program is semi-manualized, progressive, and applied in a module-based approach designed for a group setting that is to be conducted one session per week for 12 weeks. We hope that this work may form the basis for a novel and more effective treatment strategy for adolescent depression, as well as broaden the discussion on how to address this challenge.