Dialectical behavior therapy for depressed older adults - A randomized pilot study
Dialectical behavior therapy for depressed older adults - A randomized pilot study
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DOI：
10.1176/appi.ajgp.11.1.33
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发表时间：
2003-01-01
影响因子：
7.2
通讯作者：
Robins, CJ
中科院分区：
文献类型：
--
作者：
Lynch, TR;Morse, JQ;Robins, CJ
目的：虽然有证据表明抗抑郁药和一些个人和团体心理治疗干预措施对抑郁的老年人的疗效，但其中相当一部分对治疗没有反应。作者评估了团体心理治疗增加药物治疗的益处。研究方法：他们随机分配了34名60岁及以上的抑郁症患者（主要是慢性抑郁症患者），接受28周的抗抑郁药物治疗加临床管理，单独（MED）或加上辩证行为治疗技能培训和预定的电话辅导课程（MED + DBT）。结果如下：仅MED + DBT组的平均自评抑郁评分显著降低，两个治疗组的访谈者自评抑郁评分均显著降低且降幅大致相当。然而，在访谈者评定的抑郁症中，71%的MED + DBT患者在治疗后缓解，而MED患者为47%。在6个月的随访中，75%的MED+DBT患者缓解，而MED患者仅为31%，差异显著。只有接受MED + DBT的患者在治疗前到治疗后的依赖性和适应性应对方面表现出显着改善，这被认为是对抑郁症的易感性。结论：这项试点研究的结果表明，DBT技能培训和电话辅导可能提供承诺，以有效地增强抗抑郁药物在老年抑郁症患者的影响。
Objective: Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment Authors assessed the benefits of augmenting medication with group psychotherapy. Methods: They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED + DBT). Results: Only MED + DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED + DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31 % of MED patients, a significant difference. Only patients receiving MED + DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression. Conclusion: Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.