Dialectical Behavior Therapy for Adolescents with Bipolar Disorder: Results from a Pilot Randomized Trial
Dialectical Behavior Therapy for Adolescents with Bipolar Disorder: Results from a Pilot Randomized Trial
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DOI：
10.1089/cap.2013.0145
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发表时间：
2015-03-01
影响因子：
1.9
通讯作者：
Birmaher, Boris
中科院分区：
文献类型：
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作者：
Goldstein, Tina R.;Fersch-Podrat, Rachael K.;Birmaher, Boris
目的：本研究的目的是进行一项试验性随机试验，辩证行为疗法（DBT）与心理社会治疗，如往常（TAU）诊断为双相情感障碍（BP）的青少年。方法：我们招募了参与者12-18岁的主要BP诊断（I，II，或操作不另行规定[NOS]标准）从儿科专科诊所。合格患者采用2：1随机化结构分配至DBT组（n=14）或心理社会TAU组（n=6）。所有患者均接受研究附属精神科医生的药物管理。DBT包括36个课程（18个个人，18个家庭技能培训）超过1年。TAU是一种折衷的心理治疗方法，包括心理教育，支持和认知行为技术。一个独立的评估，盲目的治疗条件，评估结果，包括情感症状，自杀意念和行为，非自杀性自伤行为，情绪失调，每季度超过1 year.Results：青少年接受DBT出席了显着更多的治疗会议超过1年的青少年接受TAU，可能反映了更大的参与和保留;青少年和家长对这两种治疗方法的接受程度都很高。与接受TAU治疗的青少年相比，接受DBT治疗的青少年在随访期间表现出明显较轻的抑郁症状，自杀意念改善的可能性几乎是接受TAU治疗的青少年的三倍。模型表明，在接受DBT的青少年中，在随访期间，有较大的效应量，在更多的周内处于正常状态。虽然没有组间差异躁狂症状或情绪失调与治疗，青少年接受DBT，但不是那些接受TAU，证明改善从治疗前到治疗后的躁狂症状和情绪dysregulation.Conclusions：DBT可能提供承诺作为一种辅助药物治疗的抑郁症状和自杀意念的青少年与BP。DBT对治疗承诺的关注可能对早发性BP的治疗很重要。需要更大规模的对照试验来确定这种方法的有效性，检查对自杀行为的影响，并证明成本效益。
Objective: The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP).Methods: We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year.Results: Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation.Conclusions: DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for adolescents with BP. The DBT focus on commitment to treatment may be important for the treatment of early-onset BP. Larger controlled trials are needed to establish the efficacy of this approach, examine impact on suicidal behavior, and demonstrate cost effectiveness.