Telephone-based cognitive behavioral therapy for depression in Parkinson disease A randomized controlled trial

被引:69
|
作者
Dobkin, Roseanne D. [1 ,3 ]
Mann, Sarah L. [3 ]
Gara, Michael A. [1 ]
Interian, Alejandro [3 ]
Rodriguez, Kailyn M. [1 ]
Menza, Matthew [1 ,2 ]
机构
[1] Rutgers Robert Wood Johnson Med Sch, Dept Psychiat, Piscataway, NJ 08903 USA
[2] Rutgers Robert Wood Johnson Med Sch, Dept Neurol, Piscataway, NJ USA
[3] VA New Jersey Hlth Care Syst, Lyons, NJ 07939 USA
关键词
QUALITY-OF-LIFE; HEALTH-CARE UTILIZATION; DIAGNOSTIC-CRITERIA; SELF-MANAGEMENT; SYMPTOMS; PREDICTORS; ANXIETY; PEOPLE; IMPACT; DISORDERS;
D O I
10.1212/WNL.0000000000009292
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective To determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU. Methods Seventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs' unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., "I have no control"; "I am helpless") and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat. Results T-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and -0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement. Conclusions T-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care. Clinicaltrials.gov identifier NCT02505737. Classification of evidence This study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.
引用
收藏
页码:E1764 / E1773
页数:10
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