Maintenance Cognitive-Behavioral Therapy and Manualized Psychoeducation in the Treatment of Recurrent Depression: A Multicenter Prospective Randomized Controlled Trial

作者：Stangier Ulrich^*; Hilling Christine; Heidenreich Thomas; Risch Anne Katrin; Barocka Arnd; Schloesser Ralf; Kronfeld Kai; Ruckes Christian; Berger Hartmut; Roeschke Joachim; Weck Florian; Volk Stephan; Hambrecht Martin; Serfling Richard; Erkwoh Ralf; Stirn Aglaja; Sobanski Thomas; Hautzinger Martin

来源：American Journal of Psychiatry, 2013, 170(6): 624-632.

DOI：10.1176/appi.ajp.2013.12060734

Objective: This multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression. %26lt;br%26gt;Method: This was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more-previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation. %26lt;br%26gt;Results: Cox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a significant interaction was observed between treatment condition and number of previous episodes (%26lt;5 or %26gt;= 5). Within the subsample of patients with five or more previous episodes, maintenance CBT was significantly superior to manualized psychoeducation, whereas for patients with fewer than five previous episodes, no significant treatment differences were observed in time to relapse or recurrence. %26lt;br%26gt;Conclusions: The results indicate that maintenance CBT has significant effects on the prevention of relapse or recurrence only in patients with a high risk of depression recurrence. For patients with a moderate risk of recurrence, nonspecific effects and structured patient education may be equally effective.

• 出版日期2013-6