The Efficacy of Group Psychotherapy for Depression: A Meta-analysis and Review of the Empirical Research

We conducted a meta-analysis of 48 research reports on the efficacy of group therapy for depression. In 15 studies in which treated participants were compared to untreated controls, the average effect size was 1.03, suggesting that the average treated participant was better off than about 85% of the untreated participants. Analyses of clinically significant change suggested that treated participants improved substantially. However, even after treatment, participants still had pronounced depressive symptomatology relative to normative levels of depressive symptoms seen in non-depressed individuals. We conclude that group therapy is an efficacious treatment for depressed patients. However, numerous questions remain unanswered. For example, little empirical work has investigated what advantages group therapy might have over individual therapy. We conclude by making recommendations for future research in this area.     

心理干预对抑郁症患者复发因素的影响

目的探讨心理干预对抑郁症患者复发因素的影响。方法将85例抑郁症患者随机分为干预组(药物 心理干预)及对照组(单纯药物治疗),分别于入组前及1年后进行SDS、HAMD、MMPI、P300电位测定。结果心理干预后干预组SDS(35.4±5.3)、HAMD(17.5±3.1)量表分明显低于对照组(41.7±6.1,F=4.1,21.1±5.5,F=4.2,P<0.05);干预组MMPI中F、Hs、D、Hy、Pd、Pt、Ma量表分明显低于对照组(F=3.9-7.7,P<0.01或P<0.05);干预组P300电位中N2、P3潜伏期较对照组明显缩短、P3波幅较对照组明显升高(P<0.01或P<0.05);干预后干预组的再次复发率(17.8%)明显低于对照组(47.5%,χ2=14.38,P<0.01)。结论心理干预配合药物治疗对抑郁症患者的情绪、人格及认知等复发因素具有积极的意义。     

Self-System Therapy (SST): A Theory-Based Psychotherapy for Depression

This article introduces Self-System Therapy (SST), a brief, structured psychotherapy for the treatment of depression. SST conceptualizes depression as a failure of self-regulation and is intended for individuals whose depression and/or premorbid functioning are characterized by particular problems in self-regulation. This article provides an overview of SST, including its origins in basic and clinical research on self-discrepancy theory and self-regulation, the hypothesized etiological role of self-regulation in depression, the primary components of the treatment, and comparisons of SST with other psycho-therapies for depression. The general structure of a course of treatment with SST is outlined, and a case example is presented to illustrate the goals and strategies of each phase.     

帕罗西汀并心理干预治疗卒中后抑郁和焦虑共病者81例临床观察

目的：探讨脑卒中后抑郁和焦虑共病对患者生活能力和神经功能康复的影响，及帕罗西汀合并心理干预临床疗效。方法：将脑卒中伴抑郁和焦虑障碍共病者81名随机分成3组，分别接受单用帕罗西汀治疗（A组）、帕岁西汀并心理治疗（B组）以及单用脑血管药物治疗（C组）。采用斯堪的那维亚脑卒中量表、Barthel指数、汉密尔顿抑郁量表、汉密尔顿焦虑量表评估疗效。结果：脑卒中患者中，抑郁和焦虑的共病率为65．9％，A组、B组各项评分与C组比较，差异均有统计学意义。结论：卒中后抑郁和焦虑病人单用帕罗西汀或合并心理治疗均能促进患者神经功能康复和提高生活质量，且帕罗西汀并心理干预的疗效更好。     

Behavioral Activation Treatments for Depression in Adults: A Meta-analysis and Review

Behavioral activation (BA) treatments for depression require patients to increase overt behavior to bring them in contact with reinforcing environmental contingencies. This meta-analysis sought to identify all randomized controlled studies of BA, determine the effect of this approach, and examine the differential effectiveness of variants. Thirty-four studies with 2,055 participants reporting symptoms of depression were included. The pooled effect size indicating the difference between BA and control conditions at posttest was 0.78. For participants who satisfied the criteria for major depressive disorder, the overall effect size of 0.74 remained large and significant. No differences in effectiveness between BA and cognitive therapy were found. BA may be considered a well-established and advantageous alternative to other treatments of depression.     

西酞普兰结合心理治疗对产后抑郁疗效观察

目的：比较单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁的临床疗效。方法：将58例符合CCMD-3抑郁症诊断标准的产后抑郁患者随机分成两组，分别给予单用西酞普兰20mg／日与西酞普兰20mg／日结合心理治疗，疗程6周。治疗前及治疗后1、2、4、6周末分别用汉密顿抑郁量表（HAMD）进行评定。结果：单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁均有比较理想的效果，但后者疗效更佳（t=2.24-6、64，P〈0．05）。结论：两酞普兰结合心理疗法治疗产后抑郁效果更好。     

团体人际心理治疗对糖尿病伴抑郁症患者的疗效

目的探讨团体人际心理治疗对糖尿病伴抑郁症患者的临床疗效。方法选取2008年5月-2012年10月收治的120例糖尿病抑郁症患者,随机分为观察组与对照组,每组60例,对照组患者单纯给予药物治疗,观察组患者在对照组的基础上给予团体人际心理治疗,治疗8周,观察比较两组患者在治疗前后的FBG、2hPBG、HbA1c值以及汉密顿抑郁量表(N)评分。结果两组治疗后N评分、FBG、2hPBG、HbA1c值明显低于治疗前(t=8.55,6.70,6.50.8.81;P<0.05);观察组患者HMAD评分、FBG、2hPBG、HbA1c值明显低于对照组(t=10.11,9.44,7.52.10.38;P<0.05);观察组总有效率(81.7%)明显高于对照组(63.3%),(χ2=9.78,P<0.05)。结论药物治疗糖尿病伴抑郁症的同时予以团体人际心理治疗,可明显改善患者的抑郁症状,显著提高临床疗效。     

Interpersonal Psychotherapy for Depression: Overview, Clinical Efficacy, and Future Directions

In this report we review the history of the development of interpersonal psychotherapy (IPT) and the content of this intervention in both its acute and maintenance treatment forms. We trace its theoretical bases to the therapeutic traditions established by Adolf Meyer and Harry Stack Sullivan, as well as to the attachment theory of Bowlby. We examine its empirical foundation in studies linking change in the social environment to the onset and maintenance of major depression. We describe two acute treatment studies of IPT, each of which suggests that short-term IPT is equivalent in efficacy to well-controlled pharmacotherapy. Two of the prophylactic studies suggest that IPT Is superior to a no-treatment or medication clinic and placebo approach in the prevention of new episodes. In examining flow IPT exerts its affect, we first consider studies of process and then studies of process as it relates to outcome. Finally, we make suggestions for future directions in research on IPT of depression.     

A Meta-Analysis of Common Factor and Specific Treatment Effects Across the Outcome Domains of the Phase Model of Psychotherapy

A meta-analysis was conducted to determine whether the relative magnitude of common factor and specific treatment effects was related to the classes of outcome domain (subjective well-being, symptoms, and life functioning) described in Howard, Lueger, Maling, and Martinovitch's 1993 phase model of psychotherapy. Effect sizes were calculated for 80 outcome studies that each contained no-treatment, common factor, and treatment groups. Contrary to hypotheses, the magnitude of both (a) common factor versus no-treatment comparisons (r = .11) and (b) common factor versus specific treatment comparisons (r = .19) did not differ across domains. The magnitude of both components of psychotherapy was consistent across a variety of variables. A notable exception was the lack of significant common factor effects in the treatment of more severe disorders.     

早期心理干预对精神分裂症后抑郁的影响

目的 探讨早期心理干顶对预防精神分裂症后抑郁的影响.方法 采用病例-对照的研究方法,将568例精神分裂症病人随机分成心理干预组和对照组,每组各284例.对照组给予抗精神病药物,心理干预组在给予抗精神病药物加心理干预.两组患者分别于治疗前和治疗8周末给予PANSS量表和汉密顿抑郁量表评定.结果 治疗8周后,心理干预组显效195例(68.7%)、有效236例(92.61%),对照组显效172例(60.6%)、有效248例(87.3%),两组显效率及有效率差异均有统计学意义(P均＜0.05).心理干预组产生中、重度抑郁症状者共56例,对照组产生中、重度抑郁症状者共86例,差异有统计学意义(P＜0.05).结论 早期心理干预能够提高治疗效果,减少精神分裂症后抑郁症状的发生.     

Computer-Delivered and Web-Based Interventions to Improve Depression,Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis

Background

Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students.

Objective

The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students.

Methods

Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality.

Results

A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40).

Conclusions

The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data.     

住院抑郁症患者团体治疗研究

目的探讨住院抑郁症患者团体治疗的效果。方法符合CCMD-3抑郁发作诊断标准的抑郁症患者60例,实验组30例进行联合治疗（药物治疗＋团体心理治疗）,对照组30例进行药物治疗。结果采用HAMD、SDS、SES及应付方式问卷进行评定。结果治疗前各量表评分实验组及对照组无明显差异。治疗后实验组及对照组HAMD、SDS评分均下降,而联合治疗组明显低于单纯药物组,自尊评分联合治疗组高于单纯药物组,差异具有显著性（P〈0.05）。治疗后应付方式中自责及合理化应付方式实验组明显低于对照组（P〈0.01）。结论联合治疗比单纯药物治疗能更有效缓解抑郁症状,减少自责,提高自尊。     

Diabetes and Depression: The Role of Social Support and Medical Symptoms

Depression in people with diabetes is linked to poor physical health. Social support and physical health have been linked to each other and to depression. The present study examined three possible models of the interrelationship among depression, social support, and diabetes-related medical symptoms. Eighty-six diabetes patients completed measures of diabetes symptoms, depression, and diabetes-related social support. Depression, social support, and diabetes-related medical symptoms were significantly related to each other. Mediation analysis indicated that the effect of social support on diabetes-related medical symptoms was fully accounted for by social support’s adverse effect on depression. Consistent with theory and research on interpersonal aspects of depression, a bi-directional relationship between depression and social support was suggested. That is, while both diabetes-related medical symptoms and social support independently contributed to depression, depression also contributed to lower social support. Findings underscore the potential importance of interpersonal factors in the physical health of individuals with diabetes.     

A Multidimensional Meta-Analysis of Psychotherapy for Bulimia Nervosa

We report a multidimensional meta-analysis of psychotherapy trials for bulimia nervosa published between 1980 and 2000, including multiple variables in addition to effect size such as inclusion and exclusion, recovery, and sustained recovery rates. The data point to four conclusions. First, psychotherapy leads to large improvements from baseline. Approximately 40% of patients who complete treatment recover completely, although 60% maintain clinically significant posttreatment symptoms. Second, individual therapy shows substantially better effects than group therapy for the therapies tested. Third, additional approaches or treatment parameters (e.g., number of sessions) need to be tested for the substantial number of patients who enter treatment and do not recover. Finally, the utility of meta-analyses can be augmented by including a wider range of outcome metrics, such as recovery rates and posttreatment symptom levels.     

团体心理治疗对乳腺癌患者焦虑抑郁情绪的影响

目的探讨团体心理治疗对乳腺癌患者焦虑抑郁情绪的影响。方法将96例乳腺癌病人随机分为两组。对照组接受常规化疗,干预组在临床治疗的同时,进行团体心理治疗,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定其情绪状况,观察比较病人在团体心理治疗8周前后SAS和SDS评分结果。结果干预组患者焦虑、抑郁情绪得到明显改善,前后比较有显著性差异(t=3.34,3.65;P<0.01)。结论乳腺癌患者在进行躯体治疗的同时,实施有效的心理治疗可以纠正患者不恰当的认知,改善其焦虑抑郁情绪,故可作为乳腺癌治疗的辅助方法应用于临床。     

家庭心理治疗与精神分裂症患者症状的缓解

目的 :探讨家庭心理治疗的康复作用。方法 :选择符合临床“痊愈”标准的精神分裂症病人。将 80例患者按匹配原则分成治疗组和对照组 ,两组病人都照常规在出院后继续进行药物维持治疗 ,但治疗组病人 ( 4 0人 )则同时接受系统家庭心理治疗。出院时及出院后半年对两组病人分别进行临床症状测评 ( SCL- 90 )及独立观察者的疗效评价。结果 :治疗组病人各种症状较出院时明显减轻 ,而对照组病人平均症状分数则基本没有变化 ;治疗组中无一例复发住院者 ,但对照组中则有 4例因症状严重而再次住院治疗。结论 :提示系统家庭心理治疗能够帮助精神分裂症患者减轻心理障碍 ,提高社会适应能力。