慢性疲劳综合征认知行为疗法治疗反应轨迹的预测因素:一项队列研究

IF 3.5 2区 医学 Q2 PSYCHIATRY
Lukas Van Oudenhove , Soetkin Debyser , Elfi Vergaelen , Stephan Claes , Maaike Van Den Houte
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引用次数: 0

摘要

背景慢性疲劳综合征(CFS)患者对认知行为疗法(CBT)的反应差异很大,但治疗成功的预测因素仍有待阐明。我们的目的是根据患者在 CBT 治疗过程中的疲劳轨迹确定患者亚组,确定亚组成员的治疗前预测因素,并厘清预测因素与治疗结果之间随时间变化的关系。在治疗前、3 次、10 次和 15 次治疗后,收集他们对疲劳、抑郁、焦虑和躯体症状、感知压力和积极情绪的自我报告水平。采用潜类增长分析法(LCGA)根据疲劳轨迹和群体成员的基线预测因素确定亚组。结果LCGA确定了四个疲劳轨迹亚组,分别为 "无改善"(23%)、"弱改善"(45%)、"中度改善"(23%)和 "强改善"(9%)。治疗前抑郁、焦虑和躯体症状水平较高,压力较大,积极情绪水平较低,这些都预示着患者属于 "无改善 "亚组。焦虑的减轻先于疲劳的减轻,而抑郁症状与疲劳之间的关系是双向的。治疗前较高的焦虑、抑郁和躯体症状水平以及感知到的压力是缺乏反应的预测因素,而焦虑和压力的减轻先于疲劳的改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of treatment response trajectories to cognitive behavioral therapy for chronic fatigue syndrome: A cohort study

Background

The response to cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) varies greatly between patients, but predictors of treatment success remain to be elucidated. We aimed to identify patient subgroups based on fatigue trajectory during CBT, identify pre-treatment predictors of subgroup membership, and disentangle the direction of predictor – outcome relationships over time.

Methods

297 individuals with CFS were enrolled in a standardized CBT program consisting of 17 sessions, with session timing variable between participants. Self-reported levels of fatigue, depressive, anxiety, and somatic symptoms, perceived stress, and positive affect were collected pre-treatment, and after 3, 10, and 15 sessions. Latent Class Growth Analysis (LCGA) was used to identify subgroups based on fatigue trajectories and baseline predictors of group membership. Cross-lagged structural equation models were used to disentangle predictor-outcome relationships.

Results

LCGA identified four fatigue trajectory subgroups, which were labelled as “no improvement” (23 %), “weak improvement” (45 %), “moderate improvement” (23 %), and “strong improvement” (9 %) classes. Higher pre-treatment levels of depressive, anxiety, and somatic symptoms, stress, and lower levels of positive affect predicted membership of the “no improvement” subgroup. Reductions in anxiety preceded reductions in fatigue, while the depressive symptoms – fatigue relationship was bidirectional.

Conclusions

On a group level, there were statistically significant reductions in fatigue after 15 sessions of CBT, with important individual differences in treatment response. Higher pre-treatment levels of anxious, depressive, and somatic symptoms and perceived stress are predictors of lack of response, with reductions in anxiety and stress preceding improvements in fatigue.
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来源期刊
Journal of Psychosomatic Research
Journal of Psychosomatic Research 医学-精神病学
CiteScore
7.40
自引率
6.40%
发文量
314
审稿时长
6.2 weeks
期刊介绍: The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.
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