Treatment expectations for cognitive-behavioral therapy and light therapy for seasonal affective disorder: Change across treatment and relation to outcome.
Treatment expectations for cognitive-behavioral therapy and light therapy for seasonal affective disorder: Change across treatment and relation to outcome.
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DOI：
10.1037/ccp0000121
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发表时间：
2016-10
影响因子：
5.9
通讯作者：
Rohan, Kelly J.
中科院分区：
文献类型：
--
作者：
Meyerhoff, Jonah;Rohan, Kelly J.
研究冬季季节性情感障碍（SAD）临床试验过程中治疗期望和治疗结果之间的动态关系。目前患有季节性复发性抑郁症的抑郁成年人（N = 177）被随机分配到6周的SAD认知行为治疗（CBT-SAD）或光疗法（LT）。大多数为女性（83.6%）和白色（92.1%），平均年龄为45.6岁。使用修改后的治疗预期和可信度调查评估了CBT-SAD和LT的治疗预期。抑郁症的严重程度进行了评估，使用贝克抑郁症量表-第二版。在治疗前、治疗中和治疗后进行所有测量。随着治疗的进展，对接受治疗的期望在CBT-SAD患者中随时间急剧增加，在LT患者中适度增加。随着时间的推移，治疗期望值较高的患者的抑郁严重程度低于治疗期望值较低的患者。在交叉滞后面板路径分析中，有一个显着的效果，在治疗中的治疗期望在治疗后的抑郁严重程度在CBT-SAD患者。治疗预期在治疗期间发生变化，影响结局，应在整个治疗期间反复评估和监测。研究结果表明，在治疗中期的治疗期望是CBT-SAD减少抑郁症的一种机制，这应该在SAD样本中复制，并检查对非季节性抑郁症的普遍性。这些发现强调了进一步研究治疗期望在介导CBT在抑郁症和其他类型的精神病理学中的作用的重要性。这项研究强调了在治疗期间反复监测治疗预期的重要性，无论治疗类型如何。此外，治疗师管理基于认知的治疗抑郁症应积极参加的程度，患者的“买入”在治疗早期，因为它有明确的迹象，抑郁症的严重程度在治疗终点。
To examine the dynamic relationship between treatment expectations and treatment outcome over the course of a clinical trial for winter seasonal affective disorder (SAD). Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6-weeks of group-delivered cognitive-behavioral therapy for SAD (CBT-SAD) or light therapy (LT). The majority was female (83.6%) and white (92.1%), with a mean age of 45.6 years. Treatment expectations for CBT-SAD and LT were assessed using a modification of the Treatment Expectancy and Credibility Survey. Depression severity was assessed using the Beck Depression Inventory-Second Edition. All measures were administered at pre-treatment, mid-treatment, and post-treatment. As treatment progressed, expectations for the treatment received increased across time steeply in CBT-SAD patients and moderately in LT patients. Collapsing across time, patients with higher treatment expectations had lower depression severity than those with lower treatment expectations. In a cross-lagged panel path analysis, there was a significant effect of treatment expectations at mid-treatment on depression severity at post-treatment among CBT-SAD patients. Treatment expectations changed across treatment, affected outcome, and should be assessed and monitored repeatedly throughout treatment. Findings suggest that treatment expectations at mid-treatment are a mechanism by which CBT-SAD reduces depression, which should be replicated in SAD samples and examined for generalizability to non-seasonal depression. These findings underscore the importance of further research examining treatment expectations in mediating CBT’s effects in depression and other types of psychopathology. This study highlights the importance of monitoring treatment expectations repeatedly during treatment regardless of treatment type. Moreover, therapists administering cognitive-based therapy for depression should actively attend to the degree of patient “buy-in” early in treatment as it has clear indications for depression severity at treatment endpoint.
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作者：
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