Brief Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Randomized Trial
Brief Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Randomized Trial
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DOI：
10.1037/a0025450
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发表时间：
2011-12-01
影响因子：
5.9
通讯作者：
Lejuez, Carl W.
中科院分区：
文献类型：
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作者：
Hopko, Derek R.;Armento, Maria E. A.;Lejuez, Carl W.
目的：重性抑郁症是乳腺癌患者最常见的精神障碍，与实质性损害有关。虽然一些研究已经探索了心理治疗对乳腺癌患者的效用，但只有2个小型试验研究了行为治疗对确诊抑郁症患者的潜在益处。方法：在一个主要是白人，受过良好教育的女性样本（年龄= 55.4岁，SD = 11.9）诊断为乳腺癌和重度抑郁症（n = 80），这项研究是一项随机临床试验测试的有效性，8个会话的行为激活治疗抑郁症（BASD）相比，解决问题的治疗。主要结果评估抑郁，环境奖励，焦虑，生活质量，社会支持和医疗结果。结果如下：在两种治疗中，结果显示治疗完整性强，患者对治疗方案满意度高，患者流失率低（19%）。意向治疗分析表明，两种治疗方法都是有效的，在所有结局指标上都证明了治疗前后的显著获益。在两种治疗中，获益与强效应量相关，并且基于应答和缓解标准、可靠的变化指数和需要治疗的人数分析，约3/4的患者表现出临床显著改善。治疗后未发现显著的组间差异。在12个月随访时维持了治疗增益，这在一定程度上支持了BTD组更强的增益维持。结论：BTD和解决问题的干预措施代表了可能改善抑郁症乳腺癌患者心理结局和生活质量的实际干预措施。最后讨论了研究的局限性和未来的研究方向。
Objective: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression. Method: In a primarily Caucasian, well-educated sample of women (age = 55.4 years, SD = 11.9) diagnosed with breast cancer and major depression (n = 80), this study was a randomized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression (BATD) compared to problem-solving therapy. Primary outcome measures assessed depression, environmental reward, anxiety, quality of life, social support, and medical outcomes. Results: Across both treatments, results revealed strong treatment integrity, excellent patient satisfaction with treatment protocols, and low patient attrition (19%). Intent-to-treat analyses suggested both treatments were efficacious, with both evidencing significant pre-post treatment gains across all outcome measures. Across both treatments, gains were associated with strong effect sizes, and based on response and remission criteria, a reliable change index, and numbers-needed-to-treat analyses, approximately 3/4 of patients exhibited clinically significant improvement. No significant group differences were found at posttreatment. Treatment gains were maintained at 12-month follow-up, with some support for stronger maintenance of gains in the BATD group. Conclusions: BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients. Study limitations and future research directions are discussed.