Adjunctive Behavioral Activation for the Treatment of Bipolar Depression: A Proof of Concept Trial.
Adjunctive Behavioral Activation for the Treatment of Bipolar Depression: A Proof of Concept Trial.
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DOI：
10.1097/pra.0000000000000142
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发表时间：
2016-03
影响因子：
1.9
通讯作者：
Miller IW
中科院分区：
文献类型：
--
作者：
Weinstock LM;Melvin C;Munroe MK;Miller IW
基于一个专注于暴露于反应偶然性正强化的模型，并有证据支持其对单极抑郁症的急性治疗效果，辅助行为激活（BA）干预可能特别适合于治疗双相抑郁症。本研究的目的是修改BA作为双相抑郁症的辅助治疗，并在概念验证试验中进行试点，以评估其对该人群的初步可行性和可接受性。从医院招募了12名患有双相情感障碍的成年人，并参加了为期20周的改良BA的公开试验，在16次门诊中进行，作为双相情感障碍社区药物治疗的辅助治疗。在治疗前和治疗后由独立评估者评估症状严重程度。治疗后还评估了患者的满意度。可行性和可接受性高，12名患者中有10名完成了治疗，16次参加的平均为14.8 (SD = 5.2)，自我报告的治疗满意度高。在抑郁症状、躁狂症状和自杀意念严重程度方面，患者在治疗前和治疗后表现出统计学上显著的改善。虽然这些研究数据是初步的，需要在更大的样本中进行复制，但这些数据表明，改良的BA干预可能为双相抑郁症的急性治疗提供了一种辅助方法。建议未来的研究采用更严格的随机对照设计，并直接评估潜在的作用机制。
Grounded in a model focused on exposure to response-contingent positive reinforcement, and with evidence supporting its acute treatment effects for unipolar depression, an adjunctive behavioral activation (BA) intervention may be especially well suited to the treatment of bipolar depression. The goal of this study was to modify BA for the adjunctive treatment of bipolar depression and to pilot it in a proof of concept trial to assess its preliminary feasibility and acceptability for this population. Twelve adults with bipolar depression were recruited from hospital settings and enrolled in a 20-week open trial of the modified BA, delivered in 16 outpatient sessions, as an adjunct to community pharmacotherapy for bipolar disorder. Symptom severity was assessed at pre- and post-treatment by an independent evaluator. Patient satisfaction was also assessed post-treatment. Feasibility and acceptability were high, with 10 of 12 patients completing treatment, an average of 14.8 (SD = 5.2) of 16 sessions attended, and high levels of self-reported treatment satisfaction. Patients exhibited statistically significant improvement from pre- to post-treatment on measures of depressive symptoms, manic symptoms, and severity of suicidal ideation. Although preliminary and requiring replication in a larger sample, these study data suggest that a modified BA intervention may offer promise as an adjunctive approach for the acute treatment of bipolar depression. Future studies that employ more rigorous randomized controlled designs and that directly assess potential mechanisms of action are recommended.