برنامه نویسی مجدد تصاویر به عنوان یک درمان مستقل کوتاه برای بیماران مبتلا به افسردگی با خاطرات مزاحم

Abstract Many depressed patients report intrusive and distressing memories of specific events in their lives. Where present, these memories are believed to act as a maintaining factor. A series of ten patients with major depressive disorder and intrusive memories, many of them reporting severe, chronic, or recurrent episodes of depression, were given an average of 8.1 sessions of imagery rescripting as a stand-alone treatment. Hierarchical linear modelling demonstrated large treatment effects that were well maintained at one year follow-up. Seven patients showed reliable improvement, and six patients clinically significant improvement. These gains were achieved entirely by working through patients' visual imagination and without verbal challenging of negative beliefs. Spontaneous changes in beliefs, rumination, and behaviour were nevertheless observed.

Results At assessment patients reported an average of 2.0 different intrusive memories (range 1–3 memories), corresponding to events occurring from age 4 years to age 48 years. They included such content as experience of medical operations and sexual abuse. Patients received a mean of 8.1 therapy sessions (range 3–19) and the mode was 7 sessions. Outcome analyses Mean scores on the BDI, composite intrusive memory measure, and composite rumination measure at baseline, end of active treatment, and 12-month follow-up are shown in Table 1. Hierarchical linear modelling analysis with the BDI (see Fig. 1) showed a highly significant effect of phase, χ2(2) = 25.38, p < 0.001, but no significant effect of time, χ2(2) = 0.89, ns, or time × phase interaction, χ2(4) = 5.42, ns. Thus although symptoms declined reliably across phases, there was no evidence that the rate of decline was significantly greater in the active treatment phase. Similar analyses on the composite intrusive memory measure (see Fig. 2) also showed a significant effect of phase, χ2(2) = 10.75, p < 0.01, but no significant effect of time, χ2(2) = 0.12, ns, or time × phase interaction, χ2(4) = 1.18, ns. The composite measure of rumination (see Fig. 3) showed a similar pattern, with a significant effect of phase, χ2(2) = 8.61, p < 0.02, but no significant effect of time, χ2(2) = 0.03, ns, or time × phase interaction, χ2(4) = 0.08, ns. Table 1. Means (standard deviations) of outcome data and treatment effect size. End of baseline End of treatment Pre-post effect size (d) 12-month follow-up Beck Depression Inventory 34.10 (9.45) 17.50 (8.80) 1.92 14.50 (17.19) Composite intrusive memory score 60.00 (19.33) 24.00 (28.58) 1.55 26.25 (31.96) Composite rumination score 59.37 (19.84) 25.25 (24.87) 1.60 25.94 (31.56) Table options Beck Depression Inventory scores for baseline (top), treatment (middle), and ... Fig. 1. Beck Depression Inventory scores for baseline (top), treatment (middle), and follow-up (bottom) periods. N.B. Dotted lines are raw scores and heavy lines are modelled values. Figure options Composite intrusive memory scores for baseline (top), treatment (middle), and ... Fig. 2. Composite intrusive memory scores for baseline (top), treatment (middle), and follow-up (bottom) periods. N.B. Dotted lines are raw scores and heavy lines are modelled values. Figure options Composite rumination scores for baseline (top), treatment (middle), and ... Fig. 3. Composite rumination scores for baseline (top), treatment (middle), and follow-up (bottom) periods. N.B. Dotted lines are raw scores and heavy lines are modelled values. Figure options Size of treatment effect The reduction in the BDI from initial assessment to post-treatment averaged 16.60 (SD 13.47). The effect size d was 1.92. Using Seggar, Lambert, and Hansen's (2002) data on the BDI to operationalise Jacobson and Truax's (1991) criteria for reliable and clinically significant change, seven patients showed reliable improvement and six showed clinically significant change. Table 1 shows that the gains were very well maintained at one year follow-up. Additional intrusive memories, number of sessions, and outcome Five patients reported experiencing between two and three additional intrusive memories that emerged during the course of therapy. The themes were always similar to the dominant intrusion. For example, two patients with childhood sexual abuse as their main intrusion experienced additional intrusive memories of sexual abuse later in life. Although the numbers were small we conducted post-hoc analyses to generate hypotheses for future studies. These suggested that patients reporting additional memories tended to have more treatment sessions, r = 0.47, 2-tailed p < 0.17, and a larger drop on the BDI, r = 0.57, 2-tailed p < 0.09. There was similarly a nonsignificant trend for patients having more treatment sessions to show greater improvement on the BDI, r = 0.52, 2-tailed p < 0.12.