非藥物療法/成人:沮喪
Non-drug Therapies: Adults Depression
來源:
一、什麼是抑鬱症？
I. What is Depression?
醫學模型
The Medical Model
美國精神病學協會將抑鬱症概念化為一種大腦“疾病”，並且在其診斷和統計手冊中，如果一個人有某些據說是該疾病特徵的“症狀”，則應做出抑鬱症的診斷。這些症狀包括情緒低落、孤獨、內疚和無價值感以及自殺念頭。其他“症狀”包括暴飲暴食、不進食、過度睡眠和無法入睡。一個人不需要具備全部甚至大部分症狀才能被診斷出患有抑鬱症。
The American Psychiatric Association has conceptualized depression as a brain “disease,” and in its Diagnostic and Statistical Manual, a diagnosis of depression is to be made if a person has certain “symptoms” said to be characteristic of the disease. These symptoms include low mood, loneliness, feelings of guilt and worthlessness, and thoughts of suicide. Other “symptoms” include over-eating, not eating, over-sleeping, and not being able to sleep. A person does not need to have all, or even most, of the symptoms in order to be diagnosed with depression.
因此，抑鬱症診斷的個人經歷各不相同。對一個人來說，這可能意味著對未來感到絕望，不睡覺，暴飲暴食；另一方面，這可能意味著感覺與他人隔絕，整天不吃飯和睡覺。
Thus, the individual experience of a depression diagnosis varies. For one person, it might mean feeling hopeless about the future, not sleeping, and over-eating; for another it might mean feeling isolated from others, not eating, and sleeping all day.
由於它被視為一種疾病，因此治療的重點是減輕症狀，而不是評估治療是否有助於一個人改變他或她的生活，從而更好地促進幸福。抗抑鬱藥被用作減輕疾病症狀的一線療法。
As it is conceived of as a disease, the treatment is focused on diminishing the symptoms, as opposed to assessing whether the treatment helps a person make changes in his or her life that might better promote well-being. Antidepressants are used as a first-line therapy for this purpose of reducing the symptoms of the disease.
社會心理模型
The Psychosocial Model
大多數社會心理干預對抑鬱症的理解不同。雖然可能有許多物理原因導致與抑鬱症相關的“症狀”，但人們的理解是，一個人的生活背景也是最重要的。生活中有許多困難會導致一個人感到沮喪——離婚、失業、社會孤立、失去親人、貧困等等——因此心理社會干預通常側重於理解這種情況，並改變一個人的生活以改變這種環境。
Most psychosocial interventions conceive of depression differently. While there may be many physical causes that lead to the “symptoms” associated with depression, the understanding is that the context of a person’s life is also of primary importance. There are many difficulties in life that can lead a person to feeling depressed—divorce, loss of a job, social isolation, loss of a loved one, poverty, and so forth—and thus psychosocial interventions often focus on understanding that context, and making changes in one’s life to alter that context.
二、結果
II. Outcomes
抑鬱症的自然過程
The Naturalistic Course of Depression
在廣泛使用抗抑鬱藥之前，抑鬱症被認為是一種發作性的疾病，大多數人預計會隨著時間的推移而康復。這種理解來自對因抑鬱症住院的人的研究，因此在住院時“嚴重”抑鬱。在此類研究中，85% 的患者將在一年內出院。50% 的患者會康復並且只有一次抑鬱症發作（長期）；另外 30% 的人可能會有周期性的抑鬱症發作（每三年左右一次）；只有 20% 的人會“長期”抑鬱。
Before the widespread use of antidepressants, depression was understood to be an episodic disorder, and that most people could be expected to recover with time. This understanding came from studies of people who had been hospitalized for depression, and thus were “severely” depressed at the time of hospitalization. In such studies, 85% of patients would be discharged within one year. Fifty percent of all patients would recover and have only a single episode of depression (over the long-term); another 30 percent might have periodic bouts of depression (once every three years or so); and only 20% would become “chronically” depressed.
今天，在抗抑鬱藥時代，抑鬱症被認為是一個更加慢性的過程。在對服用抗抑鬱藥的人進行的大型 STAR*D 研究中，進入研究的 4041 名患者中只有約 26% 的患者“病情好轉(remitted)”，而在一年結束時，只有 3% 的患者身體狀況良好且處於試驗階段。
Today, in the antidepressant era, depression is understood to run a much more chronic course. In the large STAR*D study of people taking antidepressants, only about 26% of the 4041 patients who entered the study “remitted,” and at the end of one year, only 3% were still well and in the trial.
然而，抗抑鬱藥時代的研究表明，未服藥患者的結果與抗抑鬱藥時代之前報導的自然恢復率相似。這項由 NIMH 資助的研究(^a)發現，在沒有藥物治療的情況下，超過一半 (52%) 被診斷患有抑鬱症的人在三個月內好轉，而 85% 的人在一年後不再有診斷。另一項自然主義研究(naturalistic study)發現，在研究(^b)結束時不再有抑鬱症診斷的 356 人中，其中 217 人（61%）在沒有服用抗抑鬱藥的情況下實現了這一壯舉。另一項研究(^c)發現，沒有藥物治療的緩解率更高: 10 年以上，76% 未服用抗抑鬱藥的患者康復，且從未復發。
However, research studies in the antidepressant era that have charted outcomes for unmedicated patients have found outcomes similar to the natural recovery rate reported prior to the antidepressant era. This NIMH-funded study found that without medication, more than half (52%) of people with depression diagnosis got better within three months, while 85% no longer had the diagnosis after a year. Another naturalistic study found that of 356 people who no longer had the depression diagnosis at the end of the study, 217 (61%) of them achieved that feat without taking antidepressants. Yet another study found better remission rates without medication: over 10 years, 76% of those who did not take antidepressants recovered, and never relapsed.
//a.在沒有軀體治療的情況下單相重性抑鬱的自然過程
The naturalistic course of unipolar major depression in the absence of somatic therapy
https://www.madinamerica.com/wp-content/uploads/2011/12/The%20naturalistic%20course%20of%20major%20depression%20n%20the%20absence%20of%20somatic%20therapy.PDF
//b.從廣泛的臨床、心理和生物學數據預測抑鬱症的自然過程：一種機器學習方法
Predicting the naturalistic course of depression from a wide range of clinical, psychological, and biological data: a machine learning approach
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218451/
//c.與復發相關的抑鬱症的治療：一般實踐中的 10 年隨訪
Treatment of depression related to recurrence: 10-year follow-up in general practice
https://pubmed.ncbi.nlm.nih.gov/10771465/
這種自然恢復的發生可能有很多原因：時間的流逝可能是治癒的源泉，也可能是抑鬱症的經歷可能促使人們發現和改變生活中這種痛苦的原因。
This natural recovery may occur for many reasons: the passage of time alone may be a source of healing, and it may also be that the experience of depression may motivate people to discover and alter the causes of such suffering in their lives.
抗抑鬱藥和其他軀體治療
Antidepressants and other Somatic Treatments
由於醫學模型將抑鬱症概念化為一種疾病，臨床試驗通過評估治療是否減輕疾病的“症狀”來評估治療的“療效”。在製藥公司資助的試驗中，發現抗抑鬱藥在減輕症狀方面的效果略好於安慰劑，儘管這種差異在臨床上並不顯著。長期研究表明，抗抑鬱藥會增加一個人患慢性抑鬱症和功能障礙的風險。（有關抑鬱症，請參閱藥物頁面的鏈接。）
Since the medical model conceptualizes depression as a disease, clinical trials assess “efficacy” of a treatment by assessing whether they reduce the “symptoms” of the disease. In trials funded by pharmaceutical companies, antidepressants have been found to reduce symptoms slightly better than placebo, although the difference is not seen as clinically significant. Long-term studies suggest that antidepressants increase the risk that a person will become chronically depressed and functionally impaired. (SEE LINK TO DRUG PAGE FOR DEPRESSION.)
除了基於神經學範式的藥物治療之外，還有其他干預措施。這些干預措施包括有爭議的治療方法，如電痙攣療法 (ECT)、經顱磁刺激 (TMS)、經顱直流電刺激 (tDCS) 和氯胺酮等實驗藥物。沒有充分的證據表明這些治療中的任何一種都可以減輕持續超過一個月的症狀，並且使用 ECT 和氯胺酮可能會產生許多不良反應。
There are other interventions besides medication that are based on a neurological paradigm. These interventions include controversial treatments such as electro-convulsive therapy (ECT), trans-cranial magnetic stimulation (TMS), trans-cranial direct current stimulation (tDCS), and experimental drugs such as ketamine. There is no good evidence that any of these treatments provide a reduction of symptoms that lasts beyond a month, and with both ECT and ketamine, there are many possible adverse effects.
社會心理干預
Psychosocial Interventions
對心理社會干預的研究常常因同時使用抗抑鬱藥物而變得混亂。然而，總的來說，對心理社會療法研究的嚴格審查，例如這一(^a)和這一(^b)，發現大多數（如果不是全部）心理社會干預至少與抑鬱症藥物一樣有效，但沒有抗抑鬱藥常見的副作用. 有一些證據表明，心理社會干預的長期結果也可能比抗抑鬱藥更好，儘管這些研究沒有提供與完全避免治療的抑鬱症患者的長期結果的比較。
Research on psychosocial interventions is often muddied by the concurrent use of antidepressant medications. In general, however, rigorous reviews of studies of psychosocial therapies, such as this one and this one, have found that most, if not all, psychosocial interventions are at least as effective as medications for depression, but without the adverse effects common with antidepressants. There is some evidence that long-term outcomes may also be better with psychosocial interventions than with antidepressants, although such studies don’t provide a comparison with long-term outcomes for depressed people who avoid treatment altogether.
//a. 抑鬱症治療和控制比較療效的系統評價
A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408478/
//b. 心理治療對成人抑鬱症的影響被高估：研究質量和影響大小的薈萃分析
The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size
https://pubmed.ncbi.nlm.nih.gov/19490745/
三、心理治療
III. Psychotherapies
存在廣泛的心理療法。治療的重點可能是個人的技能培養，例如如何應對壓力情況或生活轉變。其他療法側重於改變生活或改善與家人和同齡人的關係。一些療法結合了每個領域的不同方面。
A broad range of psychotherapies exist. The focus of a therapy may be on an individual’s skill-building, such as how to cope with stressful situations or life transitions. Other therapies focus on making life changes or on improving relationships with family and peers. Some therapies combine different aspects of each of these domains.
研究心理治療的方式也可能有所不同。一些療法被研究為通用方法，治療師遵循手冊。這些通常是根據它們在抑鬱量表上減少“症狀”的程度來研究的——就像研究抗抑鬱藥一樣。
The way psychotherapy is studied may also vary. Some therapies are researched as universal approaches, where a therapist follows a manual. These are usually studied in terms of how well they reduce “symptoms” on a depression scale—the same way antidepressants are studied.
然而，其他療法是量身定制的、個體化的方法。在研究時，這些療法的研究人員可能更關注客戶滿意度、生活目標的實現或整體生活質量作為更重要的指標，而不是簡單的症狀減輕。
However, other therapies are tailored, individual approaches. When studied, researchers of these therapies may focus more on client satisfaction, achievement of life goals, or overall quality of life as more important metrics, rather than simple symptom reduction.
A. 針對個體症狀的治療
A. Individual Symptom-Focused Therapies
這些類型的干預基於提高個人應對壓力情況或改變其思想或行為方面的能力。他們主要關注個人症狀的減輕，類似於抗抑鬱藥。但是，它們允許更廣泛地了解痛苦的原因。
These types of intervention are based on improving an individual’s ability to cope with stressful situations or change aspects of their thoughts or behavior. They mostly focus on individual symptom reduction, similar to antidepressants. However, they permit a wider understanding of the causes of distress.
1. 認知行為療法（CBT）
1. Cognitive-Behavioral Therapy (CBT)
CBT 是一種長期存在的、基於證據的抑鬱症治療方法，無論是在成人還是青少年中。它涉及通過積極的解決問題的過程來改變“非理性”的思想和行為。也就是說，CBT 試圖改變對世界的“錯誤信念”，以實現更好的情緒健康。對於抑鬱症的治療，一個例子是試圖改變一種信念，即一個人是失敗的，並用一種信念取而代之，即一個人可能會犯錯誤並在某些事情上失敗，而不會使整個人變得一文不值。
CBT is one of the long-standing, evidence-based treatments for depression, whether in adults or in youths. It involves a focus on changing “irrational” thoughts and behaviors through active, problem-solving processes. That is, CBT attempts to change “false beliefs” about the world to enable better emotional health. For the treatment of depression, one example would be attempting to alter a belief that one is a failure, and replacing it with the belief that one can make mistakes and fail at certain things without it making the entire person worthless.
CBT 已得到充分研究，數十年的研究發現對改善抑鬱症狀有積極作用。評論(^a)通常表明它與其他方法（例如心理動力學療法和人際關係療法）一樣有效，表明它不是唯一的循證心理療法——與通常描述的相反。
CBT is well-studied, with decades of research finding positive effects on the improvement of depressive symptoms. Reviews generally demonstrate that it is about as effective as other approaches, such as psychodynamic therapy and interpersonal therapy, indicating that it is not the only evidence-based psychotherapy—contrary to how it is commonly described.
//認知行為療法的功效：薈萃分析回顧
The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
什麼是 CBT？ | 理解認知行為療法
What is CBT? | Making Sense of Cognitive Behavioural Therapy
https://www.youtube.com/watch?v=9c_Bv_FBE-c
CBT 還成功地治療了尚未對其他治療產生反應的抑鬱症狀，一項對研究的回顧表明，對於被歸類為“治療抵抗”的人來說，它比藥物具有更好的中長期療效。
CBT has also shown success with depressive symptoms that have not yet responded to other treatments, with a review of research suggesting that it has better mid- and long-term effectiveness than pharmaceuticals for people classed as “treatment-resistant.”
//難治性抑鬱症的認知行為療法：系統評價和薈萃分析
Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis
https://www.sciencedirect.com/science/article/abs/pii/S0165178118305791?via%3Dihub
最近對心血管疾病患者的一項回顧(^a)還發現，CBT 可有效減少抑鬱和焦慮，以及“心理健康生活質量(mental health quality of life)”。
A recent review of patients with cardiovascular disease also found that CBT was effective at reducing both depression and anxiety, as well as “mental health quality of life.”
//a. 認知行為療法對心血管疾病患者抑鬱和焦慮的有效性：系統評價和薈萃分析
Effectiveness of Cognitive Behavioral Therapy for Depression and Anxiety in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis
https://journals.lww.com/psychosomaticmedicine/Citation/2018/10000/Effectiveness_of_Cognitive_Behavioral_Therapy_for.8.aspx
基於互聯網的CBT(Internet-based CBT^a)似乎也能有效減少抑鬱症，即使在被評為“嚴重”的情況下也是如此。然而，該研究中需要治療的人數 (NNT) 為 8，這表明需要 8 人接受干預才能使任何一人得到改善。
Internet-based CBT also appears to be effective for reducing depression, even in cases rated as “severe.” However, the number-needed-to-treat (NNT) in that study was eight, indicating that eight people would need to receive the intervention for any one person to improve.
//a. 基於互聯網的自我引導認知行為療法治療抑鬱症狀的療效：個體參與者數據的薈萃分析
Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms: A Meta-analysis of Individual Participant Data
https://pubmed.ncbi.nlm.nih.gov/28241179/
Cochrane 的一項綜述還發現，CBT 對治療焦慮症有效，而基於互聯網的 CBT(^a)似乎同樣有效。
A Cochrane review also found that CBT is effective for the treatment of anxiety, and that internet-based CBT appears to be just as effective.
//a. 治療師支持成人焦慮的基於互聯網的認知行為療法：證據回顧
Internet-based cognitive behavioural therapy with therapist support for anxiety in adults: a review of the evidence
另一項審查(review)表明，CBT 與其他療法一樣有效，但不一定更有效。同一篇綜述還發現，CBT 的退出率高於其他療法，這很可能表明人們發現 CBT 的耐受性低於其他療法。
Another review suggested that CBT is as effective as other therapies, but not necessarily more effective. That same review also found that CBT has a higher drop-out rate than other therapies, most likely indicating that people find CBT less tolerable than other therapies.
//成人抑鬱症的心理治療：比較結果研究的薈萃分析
Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies
https://pubmed.ncbi.nlm.nih.gov/19045960/
2. 應對抑鬱症（CWD）課程
2. Coping with Depression (CWD) Course
已經研究了基於 CBT 的“應對抑鬱症”（CWD）課程以預防抑鬱症（見上文）。然而，CWD 也被研究用於治療被診斷為抑鬱症的人。CWD 被不同地描述為“多模式群體心理教育”干預和“高度結構化的認知行為乾預”。
The CBT-based “Coping with Depression” (CWD) course has been studied for depression prevention (see above). However, CWD has also been studied for the treatment of people with a diagnosis of depression. CWD is variously described as a “multi-modal group psychoeducational” intervention and a “highly structured cognitive-behavioral intervention.”
與“預防”研究的結果一致，一項審查(^a)發現 CWD 改善了“抑鬱症狀”，尤其是對於青年和老年人群。然而，干預似乎對“少數群體”無效。該評價包括 18 項研究，得出的結論(^b)是 CWD 與其他治療抑鬱症的療法一樣有效。
Consistent with the results of the “prevention” studies, a review found that CWD improves “depressive symptoms,” especially for youth and elderly populations. However, the intervention did not appear to be effective for “minority groups.” The review included 18 studies, and resulted in the conclusion that CWD is just as effective as other therapies for the treatment of depression.
//a. 抑鬱症的心理教育治療與預防：三十年後的“應對抑鬱症”課程
Psychoeducational treatment and prevention of depression: the “Coping with Depression” course thirty years later
https://www.ncbi.nlm.nih.gov/books/NBK77775/
//b.抑鬱症的心理教育治療與預防：三十年後的“應對抑鬱症”課程
Psychoeducational treatment and prevention of depression: the “Coping with Depression” course thirty years later
https://pubmed.ncbi.nlm.nih.gov/19450912/
另一項審查(^a)發現，益處可能只是短期的，干預組和對照組之間的差異在一年的隨訪中消失。
Another review found that the benefits may be short-term only, with differences between the intervention and control groups disappearing by the one-year follow-up.
//a.閾下抑鬱症的心理治療：薈萃分析綜述
Psychological treatments of subthreshold depression: a meta-analytic review
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0447.2007.00998.x
3. 行為激活
3. Behavioral Activation
行為激活 (BA) 基於抑鬱症是一個自我維持的循環的理論：當人們開始感到沮喪時，他們會孤立自己並遠離以前喜歡的活動，這會使他們感到更加沮喪。在這種療法中，鼓勵人們參與活動和社交聯繫，即使他們不喜歡。根據該理論，這有助於通過強化愉悅體驗是可能的來幫助解決抑鬱體驗。
Behavioral activation (BA) is based on the theory that depression is a self-sustaining cycle: as people begin to feel depressed, they isolate themselves and pull away from previously-enjoyed activities, which makes them feel more depressed. In this therapy, people are encouraged to engage in activities and social connection, even if they don’t feel like it. According to the theory, this serves to help resolve depressive experiences by reinforcing that pleasurable experiences are possible.
儘管納入的研究被描述為方法學上低質量的短期研究，但一項綜述(^a)發現，BA 在改善抑鬱症狀方面明顯優於藥物。
Although the studies included were described as methodologically low-quality, short-term studies, a review found that BA was significantly better than medication for improving depressive symptoms.
//a. 抑鬱症的行為激活； 有效性和亞組分析的元分析更新
Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061095/
CBT技術：行為激活
CBT Technique: Behavioral Activation
對包括 BA 在內的各種行為干預的Cochrane 評價(^a Cochrane review)發現，它似乎與抑鬱症的其他心理社會干預一樣有效。然而，他們指出，證據的質量“非常薄弱”，尤其是與擁有大量證據基礎的 CBT 相比時。
A Cochrane review of various behavioral interventions, including BA, found that it appears to be as effective as other psychosocial interventions for depression. However, they note that the quality of the evidence was “very weak,” especially when compared to CBT, with its large evidence base.
//a.行為療法與其他心理療法治療抑鬱症
Behavioural therapies versus other psychological therapies for depression
該研究(^a)的另一項評論同樣發現，BA與其他類型的心理治療一樣有效。
Another review of the research found, similarly, that BA is as effective as other types of psychotherapy.
//a. 成人抑鬱症的心理治療：比較結果研究的薈萃分析
Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies
https://pubmed.ncbi.nlm.nih.gov/19045960/
4.接受和承諾療法（ACT）
4. Acceptance and Commitment Therapy (ACT)
ACT 基於與 CBT 類似的想法，但採用的是功能性而非機械性的方法。也就是說，ACT 關注的是思維過程或行為是否對一個人在其環境中導航有效，而不是它們是否“非理性”或“錯誤”。無論是否存在“非理性”信念，ACT 都將能夠在忠於自己的價值觀的同時朝著自己的人生目標努力。因此，ACT 的重點包括以現在為中心並參與有價值的行動的正念方法，而不是沉思過去的事件或擔心未來。
ACT is based on similar ideas to CBT, but with a functional, rather than mechanistic, approach. That is, ACT focuses on whether thought processes or behaviors are effective for a person navigating their environment, not whether they are “irrational” or “false.” ACT puts primacy on being able to work toward one’s life goals while being true to one’s values, whether there are “irrational” beliefs present or not. Thus, a focus of ACT includes mindfulness approaches of being present-centered and engaging in valued action, rather than ruminating about past events or worrying about the future.
什麼是接受和承諾療法（ACT）？
What is Acceptance and Commitment Therapy (ACT)?
對成人抑鬱症 ACT(^b) 的評論(^a)普遍發現，它至少與其他心理干預措施（如 CBT）一樣有效，並且比常規治療更有效。然而，很少有長期隨訪數據表明效果是否會隨著時間的推移而保持。
Reviews of ACT for adults with depression generally find that it is at least as effective as other psychological interventions, such as CBT, and more effective than treatment-as-usual. However, there is very little long-term follow-up data to suggest whether effects are maintained over time.
//a.“第三波”認知和行為療法與其他抑鬱症心理療法的對比（評論）
‘Third wave’ cognitive and behavioural therapies versus other psychological therapies for depression (Review)
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008704.pub2/epdf/full
//b. “第三波”認知和行為療法與抑鬱症的常規治療（評論）
‘Third wave’ cognitive and behavioural therapies versus treatment as usual for depression (Review)
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008705.pub2/epdf/full
有關 ACT 及其有效性的更多信息，請參閱此處提供的文章。
For more information about ACT and its effectiveness, see the article available here.
5. 問題解決療法
5. Problem-Solving Therapy
問題解決療法 (PST) 是 CBT 干預的一種特殊類型。與廣泛的基於思想和行為的 CBT 不同，這種療法側重於培養識別和解決生活中“問題”的“技能”。
Problem-solving therapy (PST) is a specific type of CBT intervention. Unlike broad thought- and behavior-based CBT, this therapy focuses on developing “skills” for identifying and solving “problems” in a one’s life.
對 PST 研究的回顧(^a)發現它與其他心理治療方式一樣有效。同一篇評論發現，與其他類型相比，人們不太可能退出這種類型的治療。這表明人們發現治療過程可以忍受並希望繼續。
A review of the research on PST found that it was as effective as other psychotherapy styles. That same review found that people were less likely to drop out of this type of therapy than other types. This indicates that people found the therapy process tolerable and wanted to continue.
//a. 成人抑鬱症的心理治療：比較結果研究的薈萃分析
Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies
https://pubmed.ncbi.nlm.nih.gov/19045960/
另一項審查(^a)發現了相同的結果，同時表明它在手動化時最有效，包括治療的所有方面——培訓如何處理和查看問題，以及產生替代方案和決策的具體技能，除了簡單的“問題-解決技巧。”
Another review found the same, while indicating that it was most effective when manualized to include all aspects of the therapy—training in how to approach and view problems, and specific skills for generating alternatives and decision-making, in addition to simple “problem-solving skills.”
//抑鬱症的問題解決療法：薈萃分析
Problem-solving therapy for depression: a meta-analysis
https://pubmed.ncbi.nlm.nih.gov/19299058/
6.基於正念的減壓（MBSR）和基於正念的認知療法（MBCT ）
6. Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT)
MBSR 使用正念冥想作為治療的核心元素。該理論涉及使用注意力調節來減少反芻並改善對壓力源的反應。除了正念之外，MBCT 還增加了認知技術。
MBSR uses mindfulness meditation as a core element in therapy. The theory involves the use of attention regulation to reduce rumination and improve responses to stressors. MBCT adds cognitive techniques in addition to mindfulness.
儘管由於只有少數小型研究、缺乏對照組和其他方法學限制，MBSR 研究的質量受到質疑，但總體上證據(^a)支持其用於各種心理指徵，包括被歸類為抑鬱和焦慮的經歷。
Although the quality of MBSR studies has been questioned due to just a few small studies, lack of comparison groups, and other methodological limitations, the evidence in general supports its use for a variety of psychological indications, including experiences classed as depressive and anxious.
//a. 基於正念的減壓和健康益處：薈萃分析
Mindfulness-based stress reduction and health benefits: a meta-analysis
https://www.ncbi.nlm.nih.gov/books/NBK70854/
一項研究調查(^a)了最近從抑鬱症狀中恢復過來的人。研究人員探討了哪一組會有更好的結果：MBCT 加上對停藥或僅維持藥物的支持。他們發現接受 MBCT 的人更有可能停止服用抗抑鬱藥物，而且抑鬱症復發的可能性更小。在這方面，MBCT 似乎遠遠優於抗抑鬱藥。
One study investigated people who had recently recovered from depressive symptoms. The researchers explored which group would have better outcomes: MBCT plus support for discontinuing medications, or maintaining medications only. They found that the people who were given MBCT were more likely to discontinue their antidepressant medications, and less likely to have a relapse of depression. In this regard, MBCT appeared far superior to antidepressants.
//a. 基於正念的認知療法預防復發性抑鬱症復發
Mindfulness-Based Cognitive Therapy to Prevent Relapse in Recurrent Depression
另一項研究(^a)針對被歸類為患有慢性抑鬱症的人（其中許多人服用抗抑鬱藥物而沒有康復）進行了 MBCT 研究。MBCT 非常成功。雖然沒有對照組，但貝克抑鬱量表 (BDI) 的平均改善為 10.4 分，整整 20 名 (43%) 的參與者從慢性抑鬱中緩解。
Another study looked at MBCT for people classed as having chronic depression (many of whom were taking antidepressant medications without recovering). MBCT was highly successful. Although there was no comparison group, the average improvement on the Beck depression inventory (BDI) was 10.4 points, and a full 20 (43%) of the participants remitted from their chronic depression.
//a. 難治性抑鬱症患者對正念認知療法反應良好
Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy
https://www.sciencedirect.com/science/article/pii/S0005796706000994
一項不包括對照組的試點研究(^a)也發現 MBCT 也能有效減少焦慮。
A pilot study that did not include a comparison group also found that MBCT was effective for reducing anxiety as well.
//a. 基於正念的認知療法治療廣泛性焦慮症
Mindfulness-based cognitive therapy for generalized anxiety disorder
http://spers.ca/wp-content/uploads/2013/08/Mindfullness-based-CBT-on-GAD.pdf
一篇綜述(^a)指出了 MBCT 文獻中的方法學缺陷。遵循隨機對照試驗設計的進一步研究可能有助於澄清其中一些發現。然而，初步證據有利於這種干預。
A review noted the methodological shortcomings in the MBCT literature. Further research following the randomized, controlled trial design could help clarify some of these findings. However, the preliminary evidence is good in favor of this intervention.
//基於正念的精神疾病認知療法：系統評價和薈萃分析
Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis
https://www.sciencedirect.com/science/article/abs/pii/S0165178110005196
7. 支持性心理治療
7. Supportive Psychotherapy
這種類型的個人治療基於以客戶為中心的模型，並涉及一種非指導性的方式來幫助人們提高對情緒的認識並解決問題的壓力生活事件。
This type of individual therapy is based on the client-centered model and involves a non-directive way of helping people to increase awareness of their emotions and problem-solve stressful life events.
對該研究(^a)的回顧發現，支持療法在治療抑鬱症狀方面的效果不如其他療法，儘管它仍然具有改善作用。
A review of the research found that supportive therapy was less effective at treating depressive symptoms than other therapies, although it did still have an improving effect.
//a. 成人抑鬱症的心理治療：比較結果研究的薈萃分析
Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies
https://pubmed.ncbi.nlm.nih.gov/19045960/
在對研究(^a)的一項分析（也發現支持療法效果較差）中，研究人員認為效忠效應可能是負責任的：支持療法通常被用作與研究人員的個人寵物療法的比較。根據這一理論，支持療法可能同樣好，但很少有研究人員專注於試圖讓它看起來更好。不過，這個理論很難證明。
In one analysis of the studies (which also found supportive therapy less effective) the researchers suggested that allegiance effects could be responsible: supportive therapy was often used as a comparator against the personal pet therapy of the researcher. According to this theory, supportive therapy could be just as good, but few researchers focus on trying to make it look good. Still, that theory is difficult to prove.
//a. 成人抑鬱症非指導性支持療法的療效：薈萃分析
The efficacy of non-directive supportive therapy for adult depression: A meta-analysis
https://www.sciencedirect.com/science/article/abs/pii/S0272735812000190
總而言之，支持性心理療法似乎在改善整體幸福感方面是有效的，但可能不如其他療法那麼有效。
Supportive psychotherapy, in sum, appears to be effective at improving overall well-being, but perhaps less so than other therapies.
8. 放鬆療法
8. Relaxation Therapy
旨在使客戶在生理上放鬆的干預措施，通常針對老年人。
An intervention that is designed to physiologically relax the client, usually targeted toward older adults.
對放鬆療法研究的回顧(^a)包括漸進式肌肉放鬆、瑜伽和音樂療法。研究發現，這些干預措施有效地減輕了老年人的抑鬱症狀。
A review of studies of relaxation therapy included progressive muscle relaxation, yoga, and music therapy. The study found that these interventions effectively reduced depressive symptoms in older adults.
//a.放鬆干預對老年人抑鬱和焦慮的影響：系統評價
Effects of relaxation interventions on depression and anxiety among older adults: a systematic review
https://www.tandfonline.com/doi/abs/10.1080/13607863.2014.997191
儘管對此的研究有限，但特別是帶有放鬆成分的音樂療法已顯示出減少老年人抑鬱症狀的積極作用(^a)，使其成為該人群的有希望的干預措施。
Although there is limited research on it, music therapy specifically with a relaxation component has shown a positive effect on reducing depressive symptoms in older adults, making it a promising intervention for this population.
//a. 音樂治療策略對抑鬱老年人的影響
Effects of Music Therapy Strategy on Depressed Older Adults
https://www.researchgate.net/publication/15236521_Effects_of_Music_Therapy_Strategy_on_Depressed_Older_Adults
對包括放鬆療法在內的各種行為干預措施的Cochrane 綜述(^a)發現，它似乎與抑鬱症的其他心理社會干預措施一樣有效。然而，他們指出，證據的質量“非常薄弱”，尤其是與擁有大量證據基礎的 CBT 相比時。
A Cochrane review of various behavioral interventions, including relaxation therapy, found that it appears to be as effective as other psychosocial interventions for depression. However, they note that the quality of the evidence was “very weak,” especially when compared to CBT, with its large evidence base.
//a. 行為療法與其他心理療法治療抑鬱症
Behavioural therapies versus other psychological therapies for depression
B. 人際關係療法
B. Interpersonal Therapies
這些干預措施的基礎是人們與他人交流的方式會導致他們的生活出現問題。他們專注於個人技能，但只為改善與他人的關係服務。在這些療法中，社交技能的發展被定義為提高一個人與他人互動的能力，從而增強聯繫和情緒健康。
These interventions are based on the idea that the way people communicate with others leads to problems in their lives. They focus on individual skills, but only in service of improving relationships with others. In these therapies, the development of social skills is framed as improving a person’s ability to interact with others, which enhances connection and emotional well-being.
1. 辯證行為療法（DBT）
1. Dialectical Behavior Therapy (DBT)
DBT 是一種認知行為療法，它明確地結合了關係成分。它專注於減少自殺性和非自殺性自我傷害，最常用於診斷為抑鬱症、雙相情感障礙和/或邊緣型人格障礙 (BPD) 的人。它涉及情緒調節技能的發展，以應對強烈的自殺衝動。此外，它還具有人際交往能力，旨在幫助建立更有效地滿足個人需求的社交行為。
DBT is a form of cognitive-behavioral therapy that explicitly incorporates a relational component. It is focused on reducing suicidal and non-suicidal self-injury, and is most frequently used for people with diagnoses of depression, bipolar disorder, and/or borderline personality disorder (BPD). It involves the development of emotional regulation skills to deal with intense suicidal impulses. Additionally, it features interpersonal effectiveness skills and aims to help build social behaviors that are more effective for meeting one’s needs.
一項)針對患有 BPD 診斷的女性的為期一年的 DBT 計劃的研究(^a)將接受 DBT 的人與接受不提供 DBT 的“心理治療專家”的其他治療的人進行了比較。他們發現，如果接受 DBT，女性企圖自殺的可能性會降低一半。除其他變量外，他們也不太可能住院。這使得 DBT 遠優於其他治療自殺相關問題的療法。
A study of a year-long DBT program for women with the BPD diagnosis compared those who received DBT to those receiving other treatment by “psychotherapy experts” who did not offer DBT. They found that women were half as likely to attempt suicide if they received DBT. They were also less likely to be hospitalized, among other variables. This makes DBT far superior to other therapy for suicide-related issues.
//a. 辯證行為療法與自殺行為和邊緣型人格障礙專家療法的兩年隨機對照試驗和隨訪
Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209726
什麼是青少年辯證行為療法（DBT）？
What is Dialectical behavior therapy for adolescents (DBT)?
一項針對患有 BPD 診斷的女性退伍軍人的研究(^a)發現，與常規治療相比，DBT 除了改善與自殺相關的結果外，還改善了抑鬱、絕望和憤怒表達評分。
A study in women veterans with the BPD diagnosis found that in addition to improving suicide-related outcomes, DBT also improved depression, hopelessness, and anger expression scores, compared to treatment as usual.
一項將 DBT 添加到“抑鬱老年人”藥物中的研究發現，與未服用藥物的人相比，DBT 組（也服用藥物的人）在隨訪中從抑鬱中“緩解”的人數是後者的兩倍多。 DBT。DBT 的加入似乎也改善了人際關係和適應性應對技能。
A study adding DBT to medications for “depressed older adults” found that more than twice as many in the DBT group (who also took medication) were “in remission” from depression at the follow-up, when compared to those who took medication without DBT. The addition of DBT appeared to also result in improvements in relationships and adaptive coping skills.
一項關於 DBT的小型研究集中在那些被歸類為“難治性抑鬱症”的人身上。研究人員將技能培訓組與等待名單對照組進行了比較。與等待名單上的人相比，DBT 組的人在抑鬱症狀方面有很大的改善。
A small study of DBT focused on people who had been classed with “treatment-resistant depression.” The researchers compared the skills training group component with a wait-list control group. Those in the DBT group had large improvements on depression symptoms, in terms of several scales, compared to those on the wait-list.
//a.在自然主義環境中使用辯證行為治療技能訓練治療邊緣型人格障礙
Use of dialectical behavior therapy skills training for borderline personality disorder in a naturalistic setting
有關一般 DBT 的更多信息，這裡是一篇非常詳盡的文章(^a)的鏈接。
For more information about DBT in general, here is a link to a very thorough article.
2. 人際治療（IPT）
IPT 側重於通過制定處理關係衝突的策略以及如何溝通來改善人際功能。發展人際溝通還有一個技能培養要素。從理論上講，這可以緩解抑鬱症狀。
IPT 被認為是一種得到很好支持的抑鬱症治療方法。對該研究的一項審查發現它與 CBT 一樣有效。該審查表明，大約一半的研究試驗參與者在 CBT 和 IPT 中都經歷了抑鬱症狀的緩解。
另一項審查發現 IPT 在有效性上“與藥物相似”，並且在比較中優於 CBT。
一項針對剛分娩的貧困婦女的研究發現，四次小組 IPT 在預防產後抑鬱症 (PPD) 診斷方面優於常規治療。對照組中有 6 名 (33%) 的女性被診斷為 PPD，而乾預組則沒有。
該研究的另一項審查發現 IPT 是所有心理療法中最有效的，甚至比 CBT 更有效。
3.心理動力學心理治療
當前的心理動力學療法側重於人際關係和當前的生活壓力。它藉鑑了心理動力學理論，專注於早期生活依戀風格，但與心理分析或大眾媒體中描述的心理動力學療法幾乎沒有共同之處。它可能更類似於人際治療而不是弗洛伊德的精神分析。
這種特殊類型的治療沒有像其他形式（如 CBT）那樣頻繁地被研究。
對該研究的一項回顧發現，短期心理動力學療法和 CBT 同樣有效。另一項審查發現，心理動力學療法與其他類型的心理療法一樣有效。
一項將心理動力學療法與 CBT 進行比較的研究發現，它們在初始有效性方面大致相同，儘管隨著時間的推移，CBT 的影響略大。兩種干預措施都導致不到四分之一的患者抑鬱症得到緩解，作者假設這可能是由於參與者的低收入狀況。這可能表明治療（無論是基於心理動力學的還是基於 CBT 的）對於沒有真正社會經濟問題的人來說效果更好。
4. 社交技能培訓
這種干預基於這樣一種理論，即人們參與社交互動的方式不佳，這使得其他人迴避他們或與他們發生衝突，而不是相互滿足。SST 旨在教人們如何以產生令人滿意的、積極的相遇的方式有效地與他人溝通，從而加強與他人的聯繫感。
這種干預很少單獨進行；相反，它通常是其他干預措施的組成部分，例如 CBT 或 IPT。
對各種行為干預（包括社交技能培訓）的Cochrane 綜述發現，它似乎與其他治療抑鬱症的心理社會干預一樣有效。然而，他們指出，證據的質量“非常薄弱”，尤其是與擁有大量證據基礎的 CBT 相比時。
該研究的另一項評論發現，社交技能培訓與其他類型的心理治療一樣有效。
C. 整體療法
這些療法側重於改善整體情緒健康，而不是直接減輕症狀。他們傾向於將痛苦視為對複雜生活環境的反應，並專注於使這種環境有意義。
1. 敘事療法
敘事療法是一種干預措施，旨在通過關註一個人的生活背景來解決問題。從理論上講，它是基於治療師和客戶之間的公平關係，儘管鑑於精神病系統的限制是否可以實現這一點尚不清楚。在這個過程中，治療包括解構一個人告訴自己的關於他們生活的故事，然後重建以某種方式更有幫助的故事。
敘事療法難以研究，因為它是一種主觀的、後現代的療法，難以手動化。出於這個原因，它很少，也許從未在臨床試驗中得到充分研究。然而，它在自然主義研究中表現出一定的功效。
例如，一項研究（沒有對照組進行比較）發現，50% 的參與者在抑鬱症評分方面經歷了“臨床顯著改善”。
然而，在沒有對照組或受控環境的情況下，關於治療有效性的大部分信息都是基於其從業者的主觀意見和他們的軼事經驗。
2. 存在主義療法
存在療法利用哲學的洞察力來理解使客戶接受治療的痛苦。這些干預通常以小組形式進行。它們基於這樣的理論，即存在焦慮是所有其他形式的痛苦的基礎——害怕孤獨、死亡的必然性、生命的無意義以及對自己的行為負責。存在主義治療師認為，承認這些恐懼並將其正常化可以讓人們找到生活中的個人目的和意義。在許多存在主義理論中，心理困擾被視為壓抑這些基本人類恐懼的副作用。
基於意義的療法已經在一些心理學的基礎著作中有所描述，例如維克多·弗蘭克爾的《人的意義尋找》和歐文·亞洛姆的《存在療法》 。目前的研究發現基於意義的療法可以有效地在生活中灌輸積極意義的感覺，並且至少在短期內可以減少心理困擾。然而，這些療法很少以受控方式進行研究。它們最常在患有癌症和艾滋病毒等危及生命的疾病的人群中進行研究。同一項研究發現，當存在主義療法遵循結構化計劃並涉及關於死亡的坦誠對話時，它們的效果最好。非指導性和避免病態主題的治療效果較差。
3.積極心理學
積極心理學的干預旨在關注對情緒困擾的整體理解，而不是關注減輕症狀。然而，這些技巧通常特別關注諸如通過幽默應對壓力、思考美好事物和思考有趣事物等主題。
一項研究觀察了患有抑鬱症、焦慮症和適應障礙診斷的人。干預是“幽默訓練”，旨在教人們如何通過幽默應對壓力情況。一組接受了培訓，另一組沒有。研究人員發現，與未接受訓練的組相比，干預在任何心理健康量表上都沒有影響，例如抑鬱或焦慮，甚至在幽默、嚴肅和壞情緒等主題上也沒有影響。然而，接受干預的人在某些方面情況更糟：他們在“幽默訓練”後有更多的人際交往困難，並報告說這個群體本身就是對立的。
一些研究發現，積極的心理學乾預措施，例如“Fun for Wellness”在線計劃，可以略微改善心理健康。需要注意的是，在這種情況下，一些措施沒有發現效果。
然而，其他研究幾乎沒有發現任何效果，比如這個，它專注於基於在線幽默的干預。眾多技法中，只有一種施展了效果，而且那一種也微乎其微。
四。健康方法
健康計劃側重於通過飲食、鍛煉、團體活動和其他社交活動來改善身心健康。人們的想法是，隨著人們變得更健康、找到放鬆的方法以及更多地與他人交往，抑鬱症可能會減輕。
1. 運動
運動改善青少年抑鬱症狀和生活質量的證據是最近才出現的，但很有希望。在成人中，最近的一項評論發現，運動（尤其是與教練一起進行的適度有氧運動）具有“巨大而顯著的抗抑鬱作用”，並且由於發表偏倚，其益處可能被低估了。
一項評論發現，運動與心理治療以及抑鬱症藥物一樣好。另一項評論發現，運動與舍曲林（Zoloft）一樣好。此外，一項研究發現，經常鍛煉的患有抑鬱症的人死於心臟相關疾病的可能性較小。
另一項研究發現，從長遠來看，輕度運動比平時的治療效果稍好，但相差不大。然而，適度和劇烈運動並不比平時的治療好。
儘管個別研究似乎對鍛煉非常有利，但分析所有研究的評論卻更加模棱兩可。例如，Cochrane 評價發現許多方法學缺陷滲透到運動研究中（例如，缺乏盲法，未使用意向治療分析）。當他們只包括進行得非常好的研究時，運動的有效性就會大大下降。儘管如此，在他們的分析中，運動仍然與認知療法一樣好。
進一步的研究需要與其他對照組驗證這些發現，並將發現與其他心理干預進行比較。然而，鑑於缺乏副作用和已知的運動益處，這是一種非常有希望的干預措施。
2. 瑜伽
運動研究的一個子集。關於瑜伽作為抑鬱症干預的研究是有限的。很少進行對照研究。然而，對那些確實存在的研究的評論發現，瑜伽似乎可以有效降低抑鬱症評分。最近的一項評論發現，瑜伽在效果上與運動或抗抑鬱治療沒有區別。
一項針對女性的研究發現，在降低抑鬱測量得分方面，基於正念的瑜伽干預與經常走路一樣好。該研究還發現，瑜伽干預比步行更能減少沉思（反复思考不可改變的過去或擔心未來）。
一項包括瑜伽在內的運動研究發現，瑜伽和更劇烈的運動“至少與醫生平時的治療一樣有效”。
評論還指出，有關瑜伽的研究尚不清楚，可能存在偏見。隨著進行更嚴格的研究，我們可能會看到這種干預的有效性降低。
3. 飲食
根據研究文獻，健康飲食似乎主要由蔬菜、水果、魚和堅果組成，加工食品很少，高脂肪和高糖含量的食物也很少。研究中針對抑鬱症的飲食干預採取了多種形式，包括減少熱量攝入、減少脂肪攝入和增加健康食品的攝入。
一項對研究文獻的回顧發現，只有略低於一半（47%）的關於飲食治療抑鬱症的研究發現了積極的影響。這讓人質疑這種干預的有效性。
然而，最近對該研究的大規模審查集中在那些確實發現影響的研究中共享了哪些因素。
他們發現干預措施對減輕抑鬱症狀有積極作用，但僅限於女性。男性可能要么沒有改善，要么實際上有惡化的抑鬱症狀。這可能是由於對女性身體形象和節食的文化期望。
這些干預措施也只有在營養師/營養師的帶領下才能成功。如果它們由其他治療專業人員進行，它們似乎對抑鬱症狀沒有影響。
最成功的干預措施是針對減少脂肪攝入和熱量攝入的干預措施。出於某種原因，專注於改善整體營養的干預措施有時有效，有時無效——平均起來沒有實際效果。
大多數關於飲食的試驗都使用了“亞閾值”樣本——沒有診斷出抑鬱症的人。他們分析了飲食對抑鬱量表測量的體驗的影響，但目前尚不清楚這如何推廣到那些具有真正強烈體驗且符合診斷標準的人。
在這些研究中，改善飲食似乎對焦慮幾乎沒有影響。
一項研究在實際診斷為抑鬱症的樣本中檢查了地中海飲食，確實發現它顯著改善了症狀。在這項小型研究中，由個人營養師主導個性化飲食，結果顯示非常積極。與“交友”對照組相比，接受這種飲食的人症狀完全緩解的可能性要大得多。
總之，飲食可能是其他抑鬱症治療方法的一個很好的選擇，但前提是你是一個可以有個人營養師/營養師制定的個性化計劃的女性。
4.魚油
魚油含有 omega-3 脂肪酸，包括 EPA 和 DHA。它們也被稱為多不飽和脂肪酸 (PUFA)，理論上可以在生物學水平上支持情緒健康。與抗抑鬱藥一樣，對照研究發現，與安慰劑相比，補充 omega-3 有輕微益處；然而，這種效果不太可能具有臨床意義。當在患有 PTSD 診斷的人群中進行測試時，該研究必須儘早停止：補充 omega-3 會導致由於不良事件而導致的早期退出，以及惡化的迴避和其他問題。
5. 動物
養寵物可以培養一種聯繫感，以及對他人幸福的責任感。它可以強制執行一個固定的時間表，鼓勵人們起床。它還可能需要參與為體育鍛煉和結識他人提供機會的活動（例如遛狗）。與動物的身體接觸也可能對幸福感產生影響。
儘管關於這個主題的研究很少，但研究發現，動物輔助療法可以減少抑鬱量表上的抑鬱症狀。另一項研究發現，在診斷出危及生命的疾病後，養狗與降低抑鬱症的機率有關。
研究發現養貓也有類似的結果。事實上，一項研究發現養貓的人在抑鬱量表上的得分甚至低於養狗的人，但這是一項小型研究，人們並沒有被隨機分配一隻動物。個人喜好很可能是一個因素。
然而，重要的是，如果動物的健康受到影響，抑鬱和焦慮可能會惡化。
6. 志願服務
志願服務還需要遵守時間表，並參與能夠促進人際關係以及目的感和意義感的活動。儘管對此作為心理干預的研究很少甚至不存在，但調查和軼事支持這樣一種觀點，即通過志願者工作幫助他人可以改善情緒健康。
彼得西蒙斯彙編的研究
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