Feasibility of an Integrated Treatment Approach for Youth with Depression, Suicide Attempts, and Substance Use Problems.
Feasibility of an Integrated Treatment Approach for Youth with Depression, Suicide Attempts, and Substance Use Problems.
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DOI：
10.1080/23794925.2021.1888664
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发表时间：
2021
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抑郁症、自杀行为和药物使用问题经常同时发生，对患有这些同时发生的问题的青少年的治疗往往是分散和具有挑战性的。建立在复发预防框架基础上的综合认知行为治疗方法，并应用共同的核心技能，语言和方法来治疗这些相关问题，可能在临床上是有益的。以下的综合方法的描述，我们目前的试点试验（n = 13）的结果，以检查的可接受性和可行性的认知行为治疗复发预防（CBT-RP）的干预加增强治疗照常（TAU）相比，增强TAU单独。高保留率（86%）反映了CBT-RP + TAU干预的可行性。青少年和家庭对干预措施的有益性作出积极评价，反映了这种可接受性。CBT-RP + TAU和TAU单独组中的大多数青年从研究进入到第20周都证明了抑郁和自杀意念的减少。然而，对于接受CBT-RP + TAU的青少年，减少模式更为一致，而对于一些单独接受TAU的青少年，减少速度较慢。酒精和大麻问题的减少是相似的，但仅TAU中有一半的年轻人（CBT-RP + TAU组中没有）有与精神危机或物质相关问题有关的急诊室就诊。这些研究结果，虽然基于一个小样本，强调了一个综合的认知行为复发预防方法的可行性和可接受性与抑郁症，自杀企图的历史，和物质使用问题的青年。
Depression, suicidal behaviors and substance use problems frequently co-occur, and treatment for youth with these co-occurring problems is often fragmented and challenging. An integrated cognitive-behavioral treatment approach that builds upon a relapse prevention framework and applies common core skills, language, and approach for treating these related problems may be clinically beneficial. Following a description of the integrated approach, we present results of a pilot trial (n = 13) to examine the acceptability and feasibility of the Cognitive-Behavioral Therapy – Relapse Prevention (CBT-RP) intervention plus enhanced treatment as usual (TAU) compared to enhanced TAU alone. The feasibility of the CBT-RP + TAU intervention was reflected by high rates of retention (86%). The acceptability was reflected in positive evaluations regarding the helpfulness of the intervention by adolescents and families. The majority of youth in both CBT-RP + TAU and TAU alone groups evidenced reductions in depression and suicide ideation from study entry to Week 20. Patterns of reduction were more consistent, however, for youth receiving CBT-RP + TAU, and reductions were slower to emerge for some youth receiving TAU alone. Reductions in alcohol and marijuana problems were similar, but half of the youth in TAU alone (and none in the CBT-RP + TAU group) had emergency department visits related to psychiatric crises or substance related problems. These findings, although based on a small sample, underscore the feasibility and acceptability of an integrated cognitive-behavioral relapse prevention approach for youth with depression, suicide attempt histories, and substance use problems.