A comparison of cognitive and dynamic therapy for MDD in community settings

社区环境中 MDD 认知疗法和动态疗法的比较

• 批准号: 7941829
• 负责人: Mary Beth Gibbons
• 金额: $ 50万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941829
• 关键词: comparison; cognitive; dynamic; therapy; MDD

DESCRIPTION (PROVIDED BY APPLICANT): The goal of the current proposal is to conduct a randomized, comparative, non-inferiority clinical trial that tests the hypothesis that a widely used form of manualized dynamic psychotherapy (supportive expressive psychodynamic therapy) is not inferior to cognitive therapy when implemented in community mental health settings for the treatment of major depressive disorder. Major depressive disorder is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime (Kessler et al., 2005). Over the past 30 years, cognitive therapy (Beck et al., 1979) has become established as the most empirically-validated psychosocial treatment for major depressive disorder (Hollon, Thase, & Markowitz, 2002). At this point in time, extensive efforts are occurring to disseminate cognitive therapy to clinical practice settings. Health systems and managed care entities have begun to accelerate dissemination of cognitive therapy to existing psychotherapists working in community agencies. Despite the large number of studies that have been done on cognitive therapy, one central question relevant to mental health care systems and agencies that has never been addressed is whether or not cognitive therapy provides superior outcomes to the typical form of psychotherapy provided by many community-based psychotherapists. If a standard form of psychotherapy (i.e., psychodynamic therapy) already common in the community produces outcomes that are not inferior to those produced by cognitive therapy, then the extensive amount of funds needed to re-train community therapists in cognitive therapy would be better spent on other quality improvement initiatives including hiring new therapists to help with the understaffing that is prevalent in the community. The Specific Aims of the current proposal are 1) to conduct a randomized non-inferiority trial to compare supportive-expressive psychodynamic therapy and cognitive therapy for patients with major depressive disorder, and 2) to assess the comparative effectiveness of supportive-expressive therapy and cognitive therapy on secondary measures of patient functioning and quality of life. Therapists working in community mental health agencies will be trained in either cognitive therapy or dynamic psychotherapy during the first year of the protocol. In addition, concurrent therapist training procedures will be implemented across the study period in order to retain the appropriate number of therapists throughout the study. Consumers seeking services at two community mental health centers will be randomized to either receive 12 sessions of cognitive therapy or dynamic psychotherapy. All psychotherapy will be provided by therapists employed at the community agency and will take place at the community agency. Consumers diagnosed with major depressive disorder at the mental health agency will be offered participation in the current protocol. Interested consumers will be consented for the study and randomized to treatment. All participants will complete a baseline interview as well as monthly assessments of depressive symptoms, functioning, and quality of life. As part of normal clinic procedures, all consumers will also complete the BASIS-24 at baseline and at each treatment session. We will evaluate whether dynamic psychotherapy is not inferior to cognitive therapy on change from baseline to endpoint of acute treatment in the HAM-D total score. If psychodynamic therapy is not inferior to cognitive therapy, the cost of re-training psychotherapists in cognitive therapy may not be warranted.

描述（由申请人提供）：当前提案的目标是进行一项随机、比较、非劣效性临床试验，测试以下假设：广泛使用的手动动态心理治疗（支持性表达心理动力疗法）形式在社区心理健康环境中实施治疗重度抑郁症时并不比认知疗法差。重度抑郁症是一种严重的致残性疾病，在美国每年折磨7%的个体，并且在其一生中折磨大约17%的个体（Kessler等人，2005年）。在过去的30年里，认知疗法（Beck等人，1979年）已成为最有效的治疗抑郁症的心理社会治疗（Hollon，Thase和Markowitz，2002）。在这个时间点上，正在进行广泛的努力，以传播认知疗法的临床实践设置。卫生系统和管理式护理实体已开始加速向在社区机构工作的现有心理治疗师传播认知疗法。尽管已经对认知疗法进行了大量的研究，但与精神卫生保健系统和机构相关的一个中心问题从未得到解决，即认知疗法是否提供优于许多社区心理治疗师提供的典型形式的心理治疗上级结果。如果一种标准形式的心理治疗（即，如果社区中已经很普遍的心理动力疗法（心理动力疗法）产生的效果不亚于认知疗法产生的效果，那么，重新培训社区治疗师进行认知疗法所需的大量资金最好用于其他质量改进举措，包括雇用新的治疗师，以帮助解决社区中普遍存在的人手不足问题。当前提案的具体目的是：1）进行一项随机非劣效性试验，以比较连续表达心理动力学治疗和认知治疗对重度抑郁症患者的疗效; 2）评估连续表达治疗和认知治疗对患者功能和生活质量次要指标的比较有效性。在社区精神卫生机构工作的治疗师将在方案的第一年接受认知疗法或动态心理疗法的培训。此外，将在整个研究期间实施同步治疗师培训程序，以在整个研究期间保留适当数量的治疗师。在两个社区精神卫生中心寻求服务的消费者将被随机分配接受12次认知治疗或动态心理治疗。所有心理治疗将由社区机构雇用的治疗师提供，并将在社区机构进行。在精神卫生机构被诊断为重度抑郁症的消费者将被提供参与目前的协议。感兴趣的消费者将同意参加这项研究，并随机接受治疗。所有参与者将完成基线访谈以及每月对抑郁症状、功能和生活质量的评估。作为正常临床程序的一部分，所有消费者还将在基线和每次治疗时完成BASIS-24。我们将评估动态心理治疗是否不劣于认知治疗，从基线到急性治疗终点的HAM-D总分的变化。如果心理动力疗法并不比认知疗法差，那么再培训心理治疗师进行认知疗法的费用就可能是不值得的。