An Idiographic Analysis of Change Processes in the Unified Transdiagnostic Treatment of Depression
An Idiographic Analysis of Change Processes in the Unified Transdiagnostic Treatment of Depression
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DOI：
10.1037/a0037403
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发表时间：
2014-12-01
影响因子：
5.9
通讯作者：
Barlow, David H.
中科院分区：
文献类型：
--
作者：
Boswell, James F.;Anderson, Lisa M.;Barlow, David H.
具体的研究方法可以提供关于具体治疗变化过程的丰富信息。目的：采用具体的、探索性的方法，本研究考察了(a) 3种跨诊断改变构念（正念、认知重评和情绪回避）的时间模式，(b)这些构念与抑郁和焦虑症状严重程度之间的关系，以及(c)在单个病例中引入特定的跨诊断干预策略时这些构念的变化。方法：患者64岁，白人，女性，以重度抑郁症为主，继发性广泛性焦虑症，采用统一方案（UP）治疗。对症状和变化结构数据进行单因素和多因素时间序列分析。结果：(a)观察到抑郁和焦虑从基线到治疗后的临床显着下降，以及正念和重新评估的临床显着增加；(b)正念的变化与抑郁和焦虑的变化相关，正念的变化暂时先于抑郁和焦虑的变化；(c)重评价的变化与抑郁的变化相关，重评价的变化在时间上先于抑郁的变化；(d)虽然其他模块也有影响，但旨在增加以现在为中心的情绪意识的UP模块对正念评分的影响最大；(e)重新评价等级受情绪监测和功能分析模块的影响最大，尽管随后的模块继续产生可衡量的影响。结论：虽然针对这个病例，但这些结果开始阐明了跨诊断认知行为疗法对合并焦虑的抑郁症的重要改变过程。
Idiographic research methods can provide rich information regarding the process of change in specific treatments. Objective: Adopting an idiographic, exploratory approach, this study examined (a) temporal patterns of 3 transdiagnostic change constructs (mindfulness, cognitive reappraisal, and emotion avoidance), (b) the relationships between these constructs and depression and anxiety symptom severity over time, and (c) changes in these constructs in relation to the introduction of specific transdiagnostic intervention strategies in a single case. Method: The case was a 64-year-old, White, female patient with principal major depressive disorder and secondary generalized anxiety disorder being treated with the Unified Protocol (UP). Univariate and multivariate time series analyses were applied to symptom and change construct data. Results: (a) Clinically significant decreases in depression and anxiety from baseline to posttreatment were observed, as well as clinically significant increases in mindfulness and reappraisal; (b) changes in mindfulness were associated with changes in depression and anxiety, and changes in mindfulness temporally preceded changes in depression and anxiety; (c) changes in reappraisal were associated with changes in depression, and changes in reappraisal temporally preceded changes in depression; (d) the UP module designed to increase present-focused emotion awareness exerted the strongest influence on mindfulness ratings, although other modules had an impact; (e) reappraisal ratings were most strongly influenced by the emotion monitoring and functional analysis module, although subsequent modules continued to have a measureable impact. Conclusions: Although specific to this case, these results begin to elucidate important processes of change in transdiagnostic cognitive-behavioral therapy for principal depression with comorbid anxiety.