青少年抑郁症的认知行为治疗研究
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摘要
青少年抑郁症是一种临床常见的精神障碍,严重危害青少年的身心健康,影响青少年的学习以及以后的成就,加重家庭负担,导致成年后各种精神卫生问题的高发,是一个重要的公共卫生问题。有效的治疗不仅缓解患者的痛苦,减轻家庭的负担,还有重要的卫生经济学意义。药物治疗和心理治疗都是目前公认的有效治疗手段。认知行为治疗(CBT)又是诸多的心理治疗流派中,被研究者对多,效果最为确切的治疗手段。大型随机对照研究证明认知行为治疗用于青少年抑郁症患者与药物治疗的效果相当。目前的循证医学认为认知行为治疗与药物治疗的联合方案可以带来最大的临床收益。故有必要制定一套适用于中国青少年抑郁症患者的认知行为治疗方案。
目的:
制定一套适合于青少年抑郁症患者的CBT治疗方案,并在临床实践中验证其疗效。
方法:
1.根据国外已有的认知行为治疗手册,结合中国青少年抑郁症的特点制定一套用于中国青少年抑郁症的CBT治疗模式手册。
2.根据手册进行临床对照试验,与药物对比认知行为治疗和药物治疗的效果。
3.对接受认知行为治疗的患者进行案例分析总结。
Depression in adolescents is a common mental disorder seen in the clinics. It can impair the psychosocial wellbeing of adolescents, influence their academic achievement and increase the family burden. It is also a major risk for various psychopathologies in adulthood. Psychotherapy and pharmacotherapy both had been proved effective in the treatment of adolescent depression. Cognitive-behavior therapy (CBT) is the best provided psychotherapy for the treatment of it with a comparable effect with pharmacological treatment. And evidence based medicine had recommended the combining usage of the two treatments. Now there is an urgent need to establish a treatment manual for using in the treatment of adolescents depression in China.PurposeTo establish a treatment manual for the treatment of adolescent depression in China and prove its effect in the clinical use.Method1. With the help of foreign manual and consideration of characteristics of Chinese depression adolescents, a treatment manual for the treatment of adolescent depression in China is established.2. Clinical control test is formed to test the effect of manual.3. A cases analyze of the adolescent patients who received the CBT treatment.
Result1. A multimodular and several stage treatment manual for the treatment of Chinese depressive adolescents is established with objectives as oriented.2. 66.7% of the adolescent depression patients who received the CBT treatment is recovered.3. Analyze of patients who receive CBT result three models of requirements.Conclusion1. The treatment manual in this research is fitted with the characteristics of the adolescent depression in China, and it is proved useful in the clinical work.2. In the CBT treatment of adolescent depression, the patients can be classified to three requirement models which should be treated with different focus.
目的:
制定一套适合于青少年抑郁症患者的CBT治疗方案,并在临床实践中验证其疗效。
方法:
1.根据国外已有的认知行为治疗手册,结合中国青少年抑郁症的特点制定一套用于中国青少年抑郁症的CBT治疗模式手册。
2.根据手册进行临床对照试验,与药物对比认知行为治疗和药物治疗的效果。
3.对接受认知行为治疗的患者进行案例分析总结。
Depression in adolescents is a common mental disorder seen in the clinics. It can impair the psychosocial wellbeing of adolescents, influence their academic achievement and increase the family burden. It is also a major risk for various psychopathologies in adulthood. Psychotherapy and pharmacotherapy both had been proved effective in the treatment of adolescent depression. Cognitive-behavior therapy (CBT) is the best provided psychotherapy for the treatment of it with a comparable effect with pharmacological treatment. And evidence based medicine had recommended the combining usage of the two treatments. Now there is an urgent need to establish a treatment manual for using in the treatment of adolescents depression in China.PurposeTo establish a treatment manual for the treatment of adolescent depression in China and prove its effect in the clinical use.Method1. With the help of foreign manual and consideration of characteristics of Chinese depression adolescents, a treatment manual for the treatment of adolescent depression in China is established.2. Clinical control test is formed to test the effect of manual.3. A cases analyze of the adolescent patients who received the CBT treatment.
Result1. A multimodular and several stage treatment manual for the treatment of Chinese depressive adolescents is established with objectives as oriented.2. 66.7% of the adolescent depression patients who received the CBT treatment is recovered.3. Analyze of patients who receive CBT result three models of requirements.Conclusion1. The treatment manual in this research is fitted with the characteristics of the adolescent depression in China, and it is proved useful in the clinical work.2. In the CBT treatment of adolescent depression, the patients can be classified to three requirement models which should be treated with different focus.
引文
1 EB Weller, RA Weller, MA Fristad, et al. The dexamethasone suppression test in hospitalized prepubertal depressed children, Am. J. Psychiatry, Feb 1984; 141: 290-291.
2 Weissman MM, Wolk S, Goldstein RB, et al, Depressed adolescents grown up. JAMA. 1999;281:1707-1713.
3 Angold A, Costello EJ, Worthman CM. Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychol Med. 1998;28:51-61.
4 Pine DS, Cohen E, Cohen P, et al. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? Am J Psychiatry, 1999, 156:133-135
5 Lewinsohn P, Clarke G, Seeley J, et al Major depression in community adolescents: age at onset, episode duration, and time to recurrence (see comments). J Am Acad Child Adolesc Psychiatry, 1994, 33:809-818
6 Essau C, Dobson K. Epidemiology of depressive disorders. In: Essau C, Petermann F, eds. Depressive Disorders in Children and Adolescents: Epidemiology, Course and Treatment. Northvale, NJ: Jason Aronson Inc; 1999:69-103.
7 Lweinsohn PM, Hops H, Roberts RE, et al.: I. Prevalence and incidence of depression and other DSM Ⅲ-R disorders I. High school students. J Abnorm Psychol, 1993, 102: 133-144.
8 杨志伟,李学荣,王国斌等,湖南省儿童青少年精神障碍现状调查与防止模式研究,中国心理卫生杂志,1997,11(5):260-262
9 张志群,郭兰婷.成都市区中学生抑郁症状及其相关因素研究,中国公共卫生,2004,20(3):
10 冯正直,张大钧。中学生抑郁症状的流行病学特征研究,中国行为 医学科学,2005,14,2:10-12
11 Rush AJ, Beck AT, Kovacs M, et al, Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy Res 1977; 1:17-37
12 Murphy G, Simons AD, Wetzel RD, et al, Cognitive therapy and pharmacotherapy. Arch Gen Psychiatry 1984; 441:33-41
13 Elkin I, Shea MT, Watkins JT, et al, National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry 1989; 46:971- 982
14 Hollon SD, DeRubeis RJ, Evans MD, et al, Cognitive therapy and pharmacotherapy for depression: singly and in combination. Arch Gen Psychiatry 1992; 49:774-78
15 Robert J. DeRubeis, Lois A. Gelfand, Tony Z. Tang, Medications Versus Cognitive Behavior Therapy for Severely Depressed Outpatients: Mega-Analysis of Four Randomized Comparisons Am J Psychiatry 1999; 156:1007-1013
16 Reinecke MA, Ryan NE, DuBois DL. Cognitivebehavioral therapy of depression and depressive symptoms during adolescence: a review and metaanalysis. J Am Acad Child Adolesc Psychiatry. 1998;37:26-34.
17 Lewinsohn PM, Clarke GN. Psychosocial treatments for adolescent depression. Clin Psychol Rev. 1999;19: 329-342.
18 Curry JF. Specific psychotherapies for childhood and adolescent depression. Biol Psychiatry. 2001; 49:1091-1100.
19 Treatment for Adolescents With Depression Study Team Fluoxetine, Cognitive-Behavioral Therapy, and Their Combination for Adolescents With Depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial JAMA, Aug 2004; 292:807-820.
20 John S. March, (letters to the editor) In reply. JAMA, Dec 2004; 292: 2578-2579
21 US Food and Drug Administration. Public Health Advisory: Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. October 15, 2004
22 Cognitive Therapy With Children and Adolescents: a casebook for clinical practice. Frank M. Dattilio
23 Weiner, I. B. Psychological disturbance in adolescence (3rd ed). New York: Wiley, 1992.
24 Raymond J. Corsini, Danny Wedding, Current Psychotherapies, 4th edition, Itasca, Illinois: F. E. Peacock Publishers Inc. 1989.197-320.
25 Gerald Corey,心理咨询与心理治疗,石林,程俊玲译,北京:中国轻工业出版社,2000.
26 Judith S.Beck,认知疗法:基础与应用,翟书涛 等译,北京:中国轻工业出版社,2001.
27 H.Thompson Prout,Douglas T.Brown,儿童青少年心理咨询与治疗,林丹华,吴波,李一飞等,北京:中国轻工业出版社,2002,252-377
28 Elizabeth E. Wagner, Clinical Practice of Cognitive Therapy With Children and Adolescents: The Nuts and bolts.
29 Reinecke MA. Dattilio FM, Freeman A, Cognitive therapy with children and adolescents: A casebook for clinical practice, 2nd ed. New York:Guilford, 2003.
30 Greg Clarke, Lynn DeBar, Evette Ludman, et al STEADY PROJECT INTERVENTION MANUAL Version June 14, 2002
31 Brent D, Holder D, Kolko D, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive treatments. Arch Gen Psychiatry 1997; 54: 877-885
32 Lewinsohn, P., Antonuccio, D., Steinmetz-Breckenridge, J.et al,. The Coping with Depression Course: A psychoeducational intervenetion for unipolar depression. 1984, Eugene, OR: Castalia Press
33 Clarke, G., Lewinsohn, P., & Hops, H. (1990). Adolescent Coping with Depression Course: Leader's manual for adolescent groups. Eugene, OR: Castalia
34 Kaslow NJ, Deering CG, Racusin GR, Depressed children and their families. Clin Psychol Rev 1994, 14:39-59
35 Sheeber L, Hops H, Davis B, Family processes in adolescent depression. Clin Child Fam Psychol Rev 2001,4:19-35
36 Birmaher B, Brent D, Kolko D et al. Clinical outcome after shortterm psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 2000, 57:29-36
37 Emslie GJ, Rush AJ, Weinberg WA et al., Double-blind randomized placebo-controlled trial of fluoxetine in depressed children and adolescents. Arch Gen Psychiatry 1997, 54:1031-1037
38 Fristad MA, Arnett MM, Gavazzi SM, The impact of psychoeducational workshops on families of mood-disordered children. Fam Ther 1998, 25:151-159
39 Kazdin, A., & Weisz, J. Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 1998,66,19-36
40 Beck AT, Ward C, Mendleson M, et al, An inventory for measuring
depression (BDI). Arch Gen Psychiatry, 1961, 4:561-571
41 Beck AT, Steer RA, Garbin MG, Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev, 1988, 8:77-100
42 Hamilton M, A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23:56-62
43 心理卫生评定量表手册(增订版),220-223
44 Hamilton M, The assessment of anxiety by rating scale. Brit J Med Psychol 1959, 32:50-55
45 心理卫生评定量表手册(增订版),253-255
46 Guy W. ECDEU Assessment Manual for Psychopharmacology. 2nd ed. Washington, DC: US Govemment, Printing Office; 1976. DHEW publication 76-388.
47 Rohde, Paul; Clarke, Gregory N.; Lewinsonhn et al Impact of Comorbidity on a Cognitive-Behavioral Group Treatment for Adolescent Depression J Am Acad Child Adolesc Psychiatry July 2001 Volume 40(7) pp 795-802
48 D Jayson, A Wood, L Kroll, J Fraser, et al, Which depressed patients respond to cognitive-behavioral treatment? J Am Acad Child Adolesc Psychiatry, 1998; 37(1): 35-9.
2 Weissman MM, Wolk S, Goldstein RB, et al, Depressed adolescents grown up. JAMA. 1999;281:1707-1713.
3 Angold A, Costello EJ, Worthman CM. Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychol Med. 1998;28:51-61.
4 Pine DS, Cohen E, Cohen P, et al. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? Am J Psychiatry, 1999, 156:133-135
5 Lewinsohn P, Clarke G, Seeley J, et al Major depression in community adolescents: age at onset, episode duration, and time to recurrence (see comments). J Am Acad Child Adolesc Psychiatry, 1994, 33:809-818
6 Essau C, Dobson K. Epidemiology of depressive disorders. In: Essau C, Petermann F, eds. Depressive Disorders in Children and Adolescents: Epidemiology, Course and Treatment. Northvale, NJ: Jason Aronson Inc; 1999:69-103.
7 Lweinsohn PM, Hops H, Roberts RE, et al.: I. Prevalence and incidence of depression and other DSM Ⅲ-R disorders I. High school students. J Abnorm Psychol, 1993, 102: 133-144.
8 杨志伟,李学荣,王国斌等,湖南省儿童青少年精神障碍现状调查与防止模式研究,中国心理卫生杂志,1997,11(5):260-262
9 张志群,郭兰婷.成都市区中学生抑郁症状及其相关因素研究,中国公共卫生,2004,20(3):
10 冯正直,张大钧。中学生抑郁症状的流行病学特征研究,中国行为 医学科学,2005,14,2:10-12
11 Rush AJ, Beck AT, Kovacs M, et al, Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy Res 1977; 1:17-37
12 Murphy G, Simons AD, Wetzel RD, et al, Cognitive therapy and pharmacotherapy. Arch Gen Psychiatry 1984; 441:33-41
13 Elkin I, Shea MT, Watkins JT, et al, National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments. Arch Gen Psychiatry 1989; 46:971- 982
14 Hollon SD, DeRubeis RJ, Evans MD, et al, Cognitive therapy and pharmacotherapy for depression: singly and in combination. Arch Gen Psychiatry 1992; 49:774-78
15 Robert J. DeRubeis, Lois A. Gelfand, Tony Z. Tang, Medications Versus Cognitive Behavior Therapy for Severely Depressed Outpatients: Mega-Analysis of Four Randomized Comparisons Am J Psychiatry 1999; 156:1007-1013
16 Reinecke MA, Ryan NE, DuBois DL. Cognitivebehavioral therapy of depression and depressive symptoms during adolescence: a review and metaanalysis. J Am Acad Child Adolesc Psychiatry. 1998;37:26-34.
17 Lewinsohn PM, Clarke GN. Psychosocial treatments for adolescent depression. Clin Psychol Rev. 1999;19: 329-342.
18 Curry JF. Specific psychotherapies for childhood and adolescent depression. Biol Psychiatry. 2001; 49:1091-1100.
19 Treatment for Adolescents With Depression Study Team Fluoxetine, Cognitive-Behavioral Therapy, and Their Combination for Adolescents With Depression: Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial JAMA, Aug 2004; 292:807-820.
20 John S. March, (letters to the editor) In reply. JAMA, Dec 2004; 292: 2578-2579
21 US Food and Drug Administration. Public Health Advisory: Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. October 15, 2004
22 Cognitive Therapy With Children and Adolescents: a casebook for clinical practice. Frank M. Dattilio
23 Weiner, I. B. Psychological disturbance in adolescence (3rd ed). New York: Wiley, 1992.
24 Raymond J. Corsini, Danny Wedding, Current Psychotherapies, 4th edition, Itasca, Illinois: F. E. Peacock Publishers Inc. 1989.197-320.
25 Gerald Corey,心理咨询与心理治疗,石林,程俊玲译,北京:中国轻工业出版社,2000.
26 Judith S.Beck,认知疗法:基础与应用,翟书涛 等译,北京:中国轻工业出版社,2001.
27 H.Thompson Prout,Douglas T.Brown,儿童青少年心理咨询与治疗,林丹华,吴波,李一飞等,北京:中国轻工业出版社,2002,252-377
28 Elizabeth E. Wagner, Clinical Practice of Cognitive Therapy With Children and Adolescents: The Nuts and bolts.
29 Reinecke MA. Dattilio FM, Freeman A, Cognitive therapy with children and adolescents: A casebook for clinical practice, 2nd ed. New York:Guilford, 2003.
30 Greg Clarke, Lynn DeBar, Evette Ludman, et al STEADY PROJECT INTERVENTION MANUAL Version June 14, 2002
31 Brent D, Holder D, Kolko D, et al. A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive treatments. Arch Gen Psychiatry 1997; 54: 877-885
32 Lewinsohn, P., Antonuccio, D., Steinmetz-Breckenridge, J.et al,. The Coping with Depression Course: A psychoeducational intervenetion for unipolar depression. 1984, Eugene, OR: Castalia Press
33 Clarke, G., Lewinsohn, P., & Hops, H. (1990). Adolescent Coping with Depression Course: Leader's manual for adolescent groups. Eugene, OR: Castalia
34 Kaslow NJ, Deering CG, Racusin GR, Depressed children and their families. Clin Psychol Rev 1994, 14:39-59
35 Sheeber L, Hops H, Davis B, Family processes in adolescent depression. Clin Child Fam Psychol Rev 2001,4:19-35
36 Birmaher B, Brent D, Kolko D et al. Clinical outcome after shortterm psychotherapy for adolescents with major depressive disorder. Arch Gen Psychiatry 2000, 57:29-36
37 Emslie GJ, Rush AJ, Weinberg WA et al., Double-blind randomized placebo-controlled trial of fluoxetine in depressed children and adolescents. Arch Gen Psychiatry 1997, 54:1031-1037
38 Fristad MA, Arnett MM, Gavazzi SM, The impact of psychoeducational workshops on families of mood-disordered children. Fam Ther 1998, 25:151-159
39 Kazdin, A., & Weisz, J. Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 1998,66,19-36
40 Beck AT, Ward C, Mendleson M, et al, An inventory for measuring
depression (BDI). Arch Gen Psychiatry, 1961, 4:561-571
41 Beck AT, Steer RA, Garbin MG, Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev, 1988, 8:77-100
42 Hamilton M, A rating scale for depression. J Neurol Neurosurg Psychiatry, 1960, 23:56-62
43 心理卫生评定量表手册(增订版),220-223
44 Hamilton M, The assessment of anxiety by rating scale. Brit J Med Psychol 1959, 32:50-55
45 心理卫生评定量表手册(增订版),253-255
46 Guy W. ECDEU Assessment Manual for Psychopharmacology. 2nd ed. Washington, DC: US Govemment, Printing Office; 1976. DHEW publication 76-388.
47 Rohde, Paul; Clarke, Gregory N.; Lewinsonhn et al Impact of Comorbidity on a Cognitive-Behavioral Group Treatment for Adolescent Depression J Am Acad Child Adolesc Psychiatry July 2001 Volume 40(7) pp 795-802
48 D Jayson, A Wood, L Kroll, J Fraser, et al, Which depressed patients respond to cognitive-behavioral treatment? J Am Acad Child Adolesc Psychiatry, 1998; 37(1): 35-9.