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Relaxation for depression

  • Review
  • Intervention

Authors

  • Anthony F Jorm,

    1. Orygen Youth Health Research Centre, Department of Psychiatry, Melbourne, VIC, Australia
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  • Amy J Morgan,

    Corresponding author
    1. University of Melbourne, Orygen Youth Health Research Centre, Parkville, Victoria, Australia
    • Amy J Morgan, Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria, 3052, Australia. ajmorgan@unimelb.edu.au.

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  • Sarah E Hetrick

    1. Orygen Youth Health Research Centre; Headspace (The National Youth Mental Health Foundation), Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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Abstract

Background

Many members of the public have negative attitudes towards antidepressants. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques.

Objectives

To determine whether relaxation techniques reduce depressive symptoms and improve response/remission.

Search methods

The register of trials kept by the Cochrane Collaboration Depression, Anxiety and Neurosis Group was searched up to February 2008. We also searched the reference lists of included studies.

Selection criteria

Studies were included if they were randomised or quasi-randomised controlled trials of relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) in participants diagnosed with depression or having a high level of depression symptoms. Self-rated and clinician-rated depression scores and response/remission were the primary outcomes.

Data collection and analysis

Two reviewers selected the trials, assessed the quality and extracted trial and outcome data, with discrepancies resolved by consultation with a third. Trial authors were approached for missing data where possible and missing data were estimated or imputed in some cases. Continuous measures were summarised using standardised mean differences and dichotomous outcomes by risk ratios.

Main results

There were 15 trials with 11 included in the meta-analysis. Five trials showed relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (SMD -0.59 (95% CI -0.94 to -0.24)). For clinician-rated depression, two trials showed a non-significant difference in the same direction (SMD -1.35 (95% CI -3.06 to 0.37)).

Nine trials showed relaxation produced less effect than psychological (mainly cognitive-behavioural) treatment on self-reported depression (SMD = 0.38 (95% CI 0.14 to 0.62)). Three trials showed no significant difference between relaxation and psychological treatment on clinician-rated depression at post intervention (SMD 0.29 (95% CI -0.18 to 0.75)).

Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments.

Authors' conclusions

Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Further research is required to investigate the possibility of relaxation being used as a first-line treatment in a stepped care approach to managing depression, especially in younger populations and populations with subthreshold or first episodes of depression.

摘要

背景

憂鬱症的放鬆治療

許多民眾對於抗憂鬱劑有負向的觀感。心理的介入比較能被接受,但是治療者需要可觀的訓練。需要較少訓練及技巧且可被接受的心理介入是必要的,才能確保有更多人願意接受治療。一種潛在的介入是放鬆技巧。

目標

評估放鬆技巧是否能減少憂鬱症狀並增進反應/症狀緩和。

搜尋策略

搜尋the Cochrane Collaboration Depression, Anxiety and Neurosis Group 中至2008年2月為止所登錄的試驗。我們也搜尋所納入的研究中的參考文獻。

選擇標準

納入診斷為憂鬱症或有高程度的憂鬱症狀的參與者,實施放鬆技巧(漸進式肌肉放鬆,放鬆想像,自動訓練)的隨機或類隨機控制試驗。主要的結果變項為參與者自評的憂鬱分數與臨床工作者所評估的憂鬱分數以及反應/症狀緩和。

資料收集與分析

兩位回顧者選擇試驗,評估其品質並擷取試驗與結果資料,若有不一致處,則諮詢第三位專家來解決。在某些情形下,以估計或內插的方式來得到可能為缺失的資料,則與試驗的作者聯繫來取得缺失的資料。使用標準化的平均差異來加總連續變項,對於二分變項則使用風險比率。

主要結論

總共有15個試驗,有11個納入後設分析。5個試驗顯示放鬆技巧與等待名單、沒有治療或最少的治療相比,降低了自評的憂鬱(SMD −0.59 (95% CI −0.94 to −0.24))。對於臨床工作者所評量的憂鬱,2個試驗顯示減少了憂鬱但並未達顯著(SMD −1.35 (95% CI −3.06 to 0.37))。9個試驗顯示放鬆技巧比心理治療(主要是認知行為治療)在自評的憂鬱上效果較小(SMD = 0.38 (95% CI 0.14 to 0.62))。3個試驗顯示放鬆技巧與心理治療相較,在臨床工作者評量的憂鬱分數上並沒有顯著差異(SMD 0.29 (95% CI −0.18 to 0.75))。比較放鬆訓練與藥物治療則發現不一致的效果,關於比較放鬆技巧與補充的與生活風格的治療的資料則相當缺乏。

作者結論

放鬆技巧與沒有治療或最少的治療相比,在降低自評的憂鬱症狀上要更為有效。然而,放鬆技巧並沒有像心理治療那麼有效。關於臨床工作者評量的憂鬱症狀的資料則較為不一致。需要更多的研究來調查使用放鬆技巧做為處理憂鬱的循序漸進治療的第一線治療的可能性,特別是對於較年輕族群與較易引起反應的族群或初次憂鬱發作的族群。

翻譯人

本摘要由彰化基督教醫院陳美雀翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

許多憂鬱症患者並沒有得到治療,或者在獲得治療上有延遲。其中一個原因是他們不喜歡抗憂鬱劑。另一個原因是特別的心理治療,例如:認知行為治療的資源是有限的。放鬆技巧是一種簡單的心理治療,可以在簡短的訓練後實施。這篇納入15個試驗的回顧發現,放鬆技巧比沒有治療或最少的治療要有效,但比不上心理治療如認知行為治療有效。放鬆技巧有潛力成為對憂鬱症的簡單第一線心理治療。對於在一定時間內沒有反應的患者,可以提供更複雜的心理治療,如認知行為治療。

摘要

放松疗法治疗抑郁症的效果评价

研究背景

很多人对抗抑郁药有抵触情绪,他们更倾向于接受心理干预疗法,但后者对心理治疗师的素质提出了更高要求。对心理治疗日益增长的需求呼唤一种要求较低、简便易行和容易接受的心理干预措施。放松疗法就是这样一种干预方法。

研究目的

评价放松疗法能否减轻抑郁症状并提高治疗有效率和缓解率。

检索策略

我们检索了Cochrane Collaboration Depression和Anxiety and Neurosis Group 中截止至2008年2月所收录的试验,并追溯纳入研究的参考文献。

标准/纳入排除标准

纳入评价放松疗法(渐进式肌肉放松、意象放松、自发训练),对抑郁症患者或有严重抑郁症状者的疗效的随机或半随机对照试验。主要结局指标包括患者自评或医师评价的抑郁量表得分,以及治疗的有效率和缓解率。

数据收集与分析

两名评价者独立完成试验筛选、质量评价和资料提取,争议由咨询第三者来解决。若资料缺失,应尽可能联系作者获取,或通过估计、推测等方法获得。使用SMD(标准化均数差)来描述连续变量,RR值(相对危险度)描述二分类变量。

主要结果

纳入15个试验,其中11个进行了Meta-分析。5个试验显示放松疗法与等待治疗组、空白对照组或最少治疗组相比,症状自评有所改善(SMD= −0.59,95%CI: −0.94~−0.24)。2个以医师评价的抑郁得分为结局指标的研究,未能发现疗效有显著差异(SMD= −1.35;95%CI: −3.06 ~0.37)。

9个试验显示,对自评抑郁分数的改善,放松疗法不如心理治疗(主要是认知行为治疗),SMD= 0.38,95%CI: 0.14~0.62;而对医师评价的抑郁分数来说,有3个试验显示两者间无显著差异(SMD=0.29;95%CI: −0.18 ~0.75)。

关于放松训练与药物治疗的比较,未得出一致的结果;几乎没有比较放松疗法与补充疗法或生活方式干预的研究。

作者结论

以自评量表衡量,放松疗法的疗效优于无治疗或最少治疗组,但却不如心理治疗组。医师评价的抑郁得分结论不明确。还需开展更多的研究来探讨在抑郁症的渐进式治疗方案中,将放松疗法作为一线治疗措施的可能性,特别是对于青少年患者、亚临床表现者或首次发作者的治疗。

Plain language summary

Relaxation for depression

Many people with depression do not get treatment or delay getting treatment. One reason for this is that they do not like antidepressants. Another is the limited availability of specialized psychological treatments, such as cognitive-behaviour therapy. Relaxation techniques are a simple psychological treatment that can be administered after brief training. The review of 15 trials found that it was better than no treatment or minimal treatment, but not as effective as psychological therapies like cognitive-behaviour therapy. Relaxation techniques have potential as a simple first-line psychological treatment for depression. Those who do not respond within a set time could be offered more complex psychological treatment such as cognitive-behaviour therapy.

概要

使用放松疗法治疗抑郁症的效果

现实生活中,许多抑郁症患者并未得到有效或及时的治疗,其原因之一是患者对抗抑郁药的排斥心理。另一个原因是专业的心理治疗(如认知行为治疗)可及性较差。放松疗法是一种简单的心理治疗方法,实施者在接受基本的训练后就可进行操作。纳入的15个研究结果显示,放松疗法抗抑郁效果优于无治疗或最少治疗组,但不如认知行为治疗等心理疗法。放松疗法有潜力成为抑郁症的一线简便心理疗法,如果患者在此基础上未获得症状的改善,可再考虑诸如认知行为治疗等复杂的心理疗法。

翻译注解

本摘要由重庆医科大学中国循证卫生保健协作网(China Effective Health Care Network)翻译。

Translated by: China Effective Health Care Network

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