COGNITIVE THERAPY AND PHARMACOTHERAPY FOR DEPRESSION

描述(改编自申请人的摘要)：这是一份5人的申请 通过NIH独立科学家奖(K02)获得多年工资支持。我有过 长期以来，人们一直在寻求整合抑郁症的心理社会和生物学模型， 我希望利用RCA来增进我对基础神经生物学和 与其性质和治疗有关的发育问题。我也想 增强我的工作与应用临床环境的相关性(有效性)。 特别是，我感兴趣的是认知疗法是否有更持久的 在治疗抑郁症方面效果优于药物。早期的研究表明 可能是这样的，但最近的NIH TDCRP发现了认知疗法 在治疗更严重的抑郁症方面不如药物有效 门诊患者和报告几乎没有任何持久影响的证据。这两套 研究因未能提供最佳实施方案而受到批评 各自的模式、早期研究中的药物和认知疗法 在TDCRP中。我们目前正在(与宾夕法尼亚大学的同事)进行一次 认知治疗与药物治疗的安慰剂对照研究 寻求解决这两种情况的更严重抑郁的门诊患者的治疗 令人担忧。我还与尼尔·雅各布森在西雅图合作了一个类似的 安慰剂对照试验，旨在确定行为激活 (实现起来更简单)完全体现了认知方面的变化 心理治疗。此外，我们计划(与宾夕法尼亚大学和拉什大学的同事)研究 在药物中加入认知疗法既可以提高反应的广度，也可以 消除了患者长期服用维持性药物的需要。 最后，我们正在与每个站点的同事合作研究 治疗对抑郁症患者后代的影响。我们认为 可以做更多的工作来研究与之相关的所有好处 治疗成功。我的目标一直是考察两者的作用 调节和用药中的心理和生物过程 治疗效果，并以最大可能的方式这样做 对实际临床实践的影响。我希望利用我日益增长的专业知识 神经生物学和发展，以更好地了解潜在的过程 抑郁症的治疗和预防，并利用这一理解 提高临床实践在应用环境中的有效性。

DESCRIPTION (Adapted from the Applicant's Abstract): This is a request for five years of salary support via a NIH Independent Scientist Award (K02). I have long sought to integrate psychosocial and biological models of depression, and I hope to use the RCA to enhance my understanding of basic neurobiology and developmental issues relevant to its nature and treatment. I also want to enhance the relevance of my work to applied clinical settings (effectiveness). In particular, I am interested in whether cognitive therapy has a more enduring effect than drugs in the treatment of depression. Earlier studies suggested that this might be the case, but the recent NIH TDCRP found cognitive therapy to be less effective than drugs in the treatment of more severely depressed outpatients and reported little evidence of any enduring effect. Both sets of studies have been criticized for failing to provide optimal implementations of the respective modalities, drugs in the earlier studies and cognitive therapy in the TDCRP. We are currently conducting (with colleagues at Penn) a placebo-controlled comparison of cognitive therapy versus drugs in the treatment of more severely depressed outpatients that seek to address both sets of concerns. I am also collaborating with Neil Jacobson in Seattle in a similar placebo-controlled trial designed to determine whether behavioral activation (which is simpler to implement) carries the full weight of change in cognitive therapy. Further, we plan to examine (with colleagues at Penn and Rush) whether adding cognitive therapy to drugs can both enhance the breadth of response and obviate the need to keep patients on long-term maintenance medications. Finally, we are collaborating with colleagues at each of these sites to study the impact of treatment on the offspring of our depressed patients. We think that more can be done to study the full range of benefits associated with successful treatment. My goal has been to examine the role of both psychological and biological processes in the moderation and medication of treatment effects and to do so in a manner that has the greatest possible impact on actual clinical practice. I hope to use my growing expertise in neurobiology and development to better understand the processes that underlie the treatment and prevention of depression and to use that understanding to enhance the effectiveness of clinical practice in applied settings.