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以正念为基础的认知疗法结合逐渐减少的支持是否能通过增强积极情感来降低重度抑郁障碍 ...
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以正念为基础的认知疗法结合逐渐减少的支持是否能通过增强积极情感来降低重度抑郁障碍复发/复发的风险？PREVENT试验的二次分析
Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial
——《咨询与临床心理学杂志》第92卷第9期, 2024年——
<Journal of Consulting and Clinical Psychology> Volume 92, Issue 9, 2024
【摘要】目的：正念认知疗法（MBCT）是维持性抗抑郁药物（M-ADM）的可行替代方案，可降低复发性抑郁的复发/再发风险（RR），但其作用机制尚未完全阐明。本次对PREVENT试验的二次分析检验了支持减量药物的MBCT（MBCT-TS）是否通过增强积极情感（PA）来部分降低RR风险。方法：在一项单盲、平行、分组随机对照试验中，有≥3次抑郁发作但目前未发作且正在服用M-ADM的成年人被随机分配接受MBCT-TS或持续维持性M-ADM。主要结果是24个月随访中的RR。在入院时和治疗后评估积极情感水平。原始PREVENT试验是预先注册的（ISRCTN 26666654），但本次二次分析没有。结果：招募了424名受试者（主要是女性和英国白人），每组随机分配212名受试者。在治疗后评估中，MBCT-TS导致的PA显著高于M-ADM（Δ=2.78，95% CI [1.47, 4.08]，p<.001）。194名受试者（100名M-ADM；94 名MBCT-TS）在随访期间经历了RR。摄入更多的PA可预测治疗过程中 RR风险降低（p<.001；风险比=.96，95% CI [0.94, 0.98]）。在治疗后未复发且数据完整的受试者中（121名M-ADM；145名MBCT-TS），从摄入到治疗后PA的增加导致后续RR风险降低（p=.04）。结论：这些发现表明，PA水平越高，RR风险越低，而MBCT-TS在一定程度上可通过增加PA在退出M-ADM时防止RR。
【关键词】抑郁；快感缺乏；正念认知疗法；积极情感
[Abstract] Objective: Mindfulness-based cognitive therapy (MBCT) is a viable alternative to maintenance antidepressant medication (M-ADM) to reduce risk of relapse/recurrence (RR) in recurrent depression, but its mechanism of action is not yet fully articulated. This secondary analysis of the PREVENT trial examined if MBCT with support to taper medication (MBCT-TS) reduces risk of RR in part by enhancing positive affect (PA). Method: In a single-blind, parallel, group randomized controlled trial, adults with ≥3 prior depressive episodes, but not currently in episode and who were taking M-ADM, were randomized to receive either MBCT-TS or ongoing maintenance M-ADM. The primary outcome was RR over 24-month follow-up. Levels of positive affect were assessed at intake and posttreatment. The original PREVENT trial was preregistered (ISRCTN 26666654), but this secondary analysis was not. Results: Four hundred and twenty-four individuals (predominantly female and of White British ethnicity) were recruited, with 212 randomized to each arm. MBCT-TS led to significantly greater PA relative to M-ADM at posttreatment assessment (Δ = 2.78, 95% CI [1.47, 4.08], p < .001). RR was experienced during follow-up by 194 individuals (100 M-ADM; 94 MBCT-TS). Greater intake PA predicted a reduced hazard of RR across treatments (p < .001; hazard ratio = .96, 95% CI [0.94, 0.98]). In individuals who had not relapsed by posttreatment with complete data (121 M-ADM; 145 MBCT-TS), greater increase in PA from intake to posttreatment mediated reduced risk of subsequent RR (p = .04). Conclusions: These findings suggest that greater levels of PA predict reduced risk of RR and that MBCT-TS in part acts to protect from RR when withdrawing from M-ADM by increasing PA.
[Key words] depression; anhedonia; mindfulness-based cognitive therapy; positive affect
论文原文：Dunn, B. D., Warbrick, L., Hayes, R., Montero-Marin, J., Reed, N., Dalgleish, T., & Kuyken, W. (2024). Does mindfulness-based cognitive therapy with tapering support reduce risk of relapse/recurrence in major depressive disorder by enhancing positive affect? A secondary analysis of the PREVENT trial. Journal of Consulting and Clinical Psychology, 92(9), 619–629. 2024.
https://doi.org/10.1037/ccp0000902
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