How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial
How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial
复制标题
DOI：
10.1017/s0033291723003665
复制
发表时间：
2024-01-10
影响因子：
6.9
通讯作者：
Goldstein，L. H.
中科院分区：
文献类型：
--
作者：
Chalder，T.;Landau，S.;Goldstein，L. H.
背景我们在一项随机对照试验中比较了分离性癫痫发作特异性认知行为疗法（DS-CBT）联合标准化医疗护理（SMC）与单独使用SMC。在12个月随访时，DS-CBT在几个次要试验结局指标上获得了更好的结局。本文的目的是评估推定的治疗mechanism.MethodsWe进行了二次调解分析的CODES审判。从英格兰、苏格兰和威尔士的二级/三级护理国家卫生服务体系招募了368名参与者。16个调解假设相对应的组合的重要试验结果和推定的调解人进行了评估。为期12个月的试验结果包括最后一个月的癫痫发作频率、工作和社会适应量表（WSAS）以及SF-12 v2，SF-12 v2是一种提供身体（PCS）和精神成分汇总（MCS）评分的生活质量指标。选择在六个月（大致对应于完成DS-CBT）进行分析的调解人包括：（一）信念的情绪，（B）回避行为的措施，（三）焦虑和（d）depress.ResultsAll推定的调解变量，除了信念的情绪被发现DS-CBT的改善。我们发现DS-CBT通过改善目标变量回避行为、焦虑和抑郁对结果变量分离性癫痫发作（DS）、WSAS和SF-12 v2 MCS评分的调节作用。唯一的变量，以调解DS-CBT的SF-12 v2 PCS score的影响是回避behavior.ConclusionsOur的研究结果在很大程度上证实了逻辑模型的基础上发展CBT的DS患者。还可以制定干预措施，专门解决有关情绪的信念，以评估它是否会改善结果。
BackgroundWe compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms.MethodsWe carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression.ResultsAll putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior.ConclusionsOur findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.