Behavioral Activation in individual setting as adjunct to a meditation group programme for patients with chronic depression

慢性抑郁症是一种高度流行的疾病，但尽管高度困扰，但在精神卫生保健中被忽视了。药物治疗的有效性和可接受性往往是有限的。因此，迫切需要心理治疗方案作为替代方案。除了人际治疗方法（如心理治疗的认知行为分析系统）的积极结果外，也有初步证据表明基于正念的认知疗法的疗效。基于这种方法，我们开发了一个将正念与慈悲冥想相结合的集体冥想计划。慈悲的具体目标是增强对自己和他人的积极态度。在两项试点研究中，我们观察到对症状的初步积极影响（Graser等人，2016; Hofmann等人，2015年）。 这些干预措施在日常生活中的实施因强烈的退缩和回避而变得复杂。然而，以前的一项针对复发性抑郁症的认知疗法RCT的积极结果（Stangier等人，2013）以及未发表的案例表明，个人环境中的行为激活弥补了团体调解计划的缺点，并显着有助于减少抑郁倾向行为。在本RCT中，将比先前的初步研究更系统地检查该组合的疗效，并将确定对照效应量。46名慢性抑郁症患者将被随机分配到a）8次集体冥想和8次单独行为激活的组合，或B）等待列表对照组。将在治疗前、治疗中、治疗后和随访时评估抑郁症状。主要结果测量是使用抑郁症状快速量表对抑郁症进行独立和盲法评定。自我报告措施将被用来评估行为和认知回避，情绪调节策略，反刍和社会适应，以及情绪调节的标准化访谈。该研究将是第一个提供治疗有效性的证据和计算控制效应量的基础。如果结果为阳性，则必须进行进一步研究，以测试与活性治疗相比的疗效。团体调解与后续个体化治疗相结合可能是慢性抑郁症患者在精神卫生保健中的一个很好的治疗选择。

Chronic depression is a highly prevalent disorder, but despite high distress neglected in mental health care. The effectiveness and acceptance of pharmacological treatment is often limited. Thus, there is urgent need for psychological treatment options as an alternative. Besides positive results of interpersonal treatment approaches such as Cognitive Behavioral Analysis System of Psychotherapy, there is also preliminary evidence for the efficacy of mindfulness-based cognitive therapy. Based on this approach, we developed a group meditation program that combined mindfulness with metta meditation. The specific aim of metta is to enhance a positive attitude towards oneself and others. In two pilot studies, we observed preliminary positive effects on symptoms (Graser et al., 2016; Hofmann et al., 2015). The implementation of these interventions into daily life is complicated by intense withdrawal and avoidance. However, the positive outcome of a former RCT of Cognitive Therapy for recurrent depression (Stangier et al., 2013) as well as from unpublished cases indicate that behavioral activation in individual setting compensate for the shortcomings of the group mediation program and significantly contribute to the reduction of depression-prone behavior. In the present RCT, the efficacy of this combination will be examined more systematically than in preceding pilot studies, and controlled effect sizes will be established. 46 patients with chronic depression will be randomized to a) either a combination of 8 sessions group meditation and 8 individual sessions behavioral activation, or b) a wait-list control group. Symptoms of depression will be assessed at pre-, intermediate-, post-treatment and follow-up. Primary outcome measure is the independent and blind rating of depression, using the Quick Inventory of depressive symptoms. Self-report measures will be used to assess behavioral and cognitive avoidance, emotion regulation strategies, rumination and social adaptation, as well as a standardized Interview of emotion regulation. The study will be the first to provide evidence for the efficacy of the treatment and a basis for the calculation of controlled effect sizes. In case of positive outcome, further studies will have to test the efficacy in comparison with active treatments. The combination of group mediation and subsequent individual treatment may be a good treatment option for patients with chronic depression in mental health care.