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psychopharmacological treatment, DTD centers on elements that negatively interfere with the course of depressive disorder, such as psychiatric and medical comorbidities, the presence of childhood trauma, symptom variability-particularly anhedonia and anxiety-concurrent substance abuse, the use of various failed therapeutic strategies, family history, and adherence issues (Rush et al., 2022).

心理药理学治疗，DTD集中于对抑郁症过程产生负面影响的因素，如精神病和医学合并症，儿童创伤的存在，症状变异性，特别是快感缺失和焦虑并发药物滥用，使用各种失败的治疗策略，家族史和依从性问题（Rush等，2022）。

The formal and structural characteristics of DTD are thus represented by the co-occurrence of clinical and developmental conditions that negatively impact the severity of depressive psychopathological manifestations. This new perspective, which encompasses psychosocial, biological, and interactive aspects, paves the way for an integrative model of therapeutic governance.

因此，DTD的形式和结构特征表现为临床和发育条件的共同出现，这些条件对抑郁性精神病理学表现的严重程度产生负面影响。这种新的观点涵盖了心理社会，生物学和互动方面，为治疗治理的综合模型铺平了道路。

Recently proposed by a consensus conference of numerous academic experts, this vision presents a revised clinical framework that includes treatment resistance and suggests the adoption of multidisciplinary, personalized, and diversified therapeutic approaches (McAllister-Williams et al., 2020). DTD presents a significant challenge, and the integration of psychotherapeutic models involving families can enhance clinical outcomes by providing greater patient support and involving families in the therapeutic process, thereby creating an environment conducive to treatment and relapse prevention.

最近由众多学术专家的共识会议提出，这一愿景提出了一个修订的临床框架，其中包括治疗耐药性，并建议采用多学科，个性化和多样化的治疗方法（McAllister-Williams等，2020）。DTD提出了一个重大挑战，涉及家庭的心理治疗模型的整合可以通过提供更多的患者支持和让家庭参与治疗过程来提高临床结果，从而创造一个有利于治疗和预防复发的环境。

The characterization of DTD suggests a substantial cultural shift to be incorporated into both clinical practice and treatment, highlighting the multifactorial nature of the disorder and the necessity to consider the various contributing factors (Paganin, 2023). Managing DTD requires a complex multidisciplinary approach that extends beyond the mere evaluation of pharmacological treatments, including psychotherapies, neurostimulat.

DTD的特征表明，临床实践和治疗都需要进行实质性的文化转变，突出了该疾病的多因素性质以及考虑各种因素的必要性（Paganin，2023）。管理DTD需要一种复杂的多学科方法，不仅限于药物治疗的评估，包括心理治疗，神经刺激。

Alongside new pharmacological treatments and neurostimulation, various forms of psychotherapy have shown potential in the treatment of DTD, especially in the presence of comorbidities such as childhood trauma and personality disorders. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP), developed for chronic depression, is particularly focused on interpersonal issues stemming from early trauma and has demonstrated some efficacy, even for patients with DTD and a history of childhood trauma (Moeller et al., 2022).

除了新的药物治疗和神经刺激外，各种形式的心理治疗在治疗DTD方面也显示出潜力，特别是在存在儿童创伤和人格障碍等合并症的情况下。为慢性抑郁症开发的心理治疗认知行为分析系统（CBASP）特别关注早期创伤引起的人际关系问题，即使对于DTD患者和有儿童创伤史的患者也显示出一定的疗效（Moeller等，2022）。

Other promising therapies include Mindfulness-Based Cognitive Therapy (MBCT), a group intervention program originally developed to prevent depression relapse, which may also be relevant for patients with DTD, and Schema Therapy, which has proven particularly useful for patients with pronounced personality traits and emotional trauma from childhood.

其他有前途的疗法包括基于正念的认知疗法（MBCT），这是一种最初开发用于预防抑郁症复发的团体干预计划，这也可能与DTD患者有关，以及图式疗法，该疗法已被证明对具有明显个性特征和童年情绪创伤的患者特别有用。

Although still relatively new in the context of DTD, Schema Therapy has shown promising results in preliminary studies, with significant positive effects on patients with chronic and difficult-to-treat depression (Arendt and Møller, 2024). From the perspective of DTD, the primary objective of treatment is the optimal control of symptoms, enhancement of quality of life, and the initiation of a personalized program that takes into account the patient's history, comorbidities, and individual needs.

尽管在DTD的背景下仍然相对较新，但模式疗法在初步研究中显示出有希望的结果，对慢性和难治性抑郁症患者具有显着的积极作用（Arendt和Møller，2024）。从DTD的角度来看，治疗的主要目标是最佳控制症状，提高生活质量，并启动考虑患者病史，合并症和个人需求的个性化计划。

Unfortunately, one of the intrinsic limitations of DTD is the lack of clinical studies specifically focused on this condition. This limitation is likely due to the complexity and still evolving nature of DTD as a clinical entity. However, by analogy, numerous studies have demonstrated the efficacy of MFT in treating depression complicated by comorbidities (Migerode et al., 2005a); (Katsuki et al., 2018); (Franz .

不幸的是，DTD的固有局限性之一是缺乏专门针对这种情况的临床研究。这种限制可能是由于DTD作为临床实体的复杂性和不断发展的性质。然而，通过类比，许多研究已经证明MFT在治疗抑郁症并发合并症方面的疗效（Migrease等，2005a）；（Katsuki等，2018）；（弗兰兹。

Multifamily Therapy involves patients and family members from multiple families, working together with mental health professionals using a variety of approaches and techniques. These groups provide a specific and transformative therapeutic intervention for psychological distress, facilitating change through individual, familial, and inter-familial relational interactions during group sessions (Paganin and Signorini, 2021).

多家庭治疗涉及来自多个家庭的患者和家庭成员，与心理健康专业人员一起使用各种方法和技术。这些小组为心理困扰提供了一种特定的变革性治疗干预措施，通过小组会议期间的个人，家族和家族间关系互动促进了变化（Paganin和Signorini，2021）。

Initiated by Peter Laqueur in the 1960s in North America, and almost simultaneously in Argentina by Jorge Garcia Badaracco, who developed multifamily psychoanalysis groups with a psychoanalytic perspective, MFT have evolved over time up to the present day. Tracing the development of MFT is complex due to its heterogeneity.

MFT于20世纪60年代在北美由彼得·拉奎尔（PeterLaqueur）发起，几乎同时在阿根廷由豪尔赫·加西亚·巴达拉科（JorgeGarciaBadaracco）发起，他从精神分析的角度发展了多家庭精神分析小组，随着时间的推移，MFT一直发展到今天。由于MFT的异质性，追踪MFT的发展是复杂的。

MFT employs diverse techniques based on various theoretical models, including systemic, psychoanalytic, Gestalt, cognitive-behavioral, psychodramatic, and psychoeducational approaches (Sempere and Fuenzalida, 2017). These interventions aim to create new perspectives for change within intra-and inter-familial and generational contexts.

MFT基于各种理论模型采用了多种技术，包括系统性，精神分析，格式塔，认知行为，心理戏剧和心理教育方法（Sempere和Fuenzalida，2017）。。

The heterogeneity of group composition facilitates the development of 'multiple transferences,' further enhanced by the participation of professionals with different backgrounds (Sempere and Fuenzalida, 2022). In this context, it becomes easier to discuss topics that are typically more difficult to address in other therapeutic settings (Borgogno, 2010).

群体组成的异质性促进了“多重转移”的发展，不同背景的专业人员的参与进一步增强了这种发展（Sempere和Fuenzalida，2022）。在这种情况下，讨论在其他治疗环境中通常更难解决的主题变得更加容易（Borgogno，2010）。

MFT can vary in structure, frequency, number and duration of sessions, participants, issues addressed, group objectives, roles of therapists, therapeutic settings, techniques, and approaches used. There is no single classification for multifamily interventions, and MFT settings can vary significantly in duration, with sessions ranging from three hours t.

MFT的结构，频率，会话的数量和持续时间，参与者，解决的问题，小组目标，治疗师的角色，治疗环境，技术和使用的方法可能会有所不同。多家庭干预没有单一的分类，MFT设置的持续时间可能会有很大差异，会议时间从三个小时不等。

 Enhancing Treatment Adherence: By actively involving families in the therapeutic process, MFT aims to improve patient adherence to treatment plans, thereby increasing the overall effectiveness of the interventions. Reducing Relapse Rates: MFT provides continuous support and coping strategies through family involvement, helping to prevent relapses and maintain long-term remission. Improving Social and Emotional Functioning: MFT seeks to enhance patients' social skills and emotional regulation by creating a more empathetic and supportive family environment. Addressing Childhood Trauma: Many patients with DTD have histories of childhood trauma that can complicate treatment.

 提高治疗依从性：通过积极让家庭参与治疗过程，MFT旨在提高患者对治疗计划的依从性，从而提高干预措施的整体有效性。降低复发率：MFT通过家庭参与提供持续的支持和应对策略，有助于预防复发并维持长期缓解。改善社交和情绪功能：MFT旨在通过创造一个更具同情心和支持性的家庭环境来提高患者的社交技能和情绪调节。解决儿童创伤：许多DTD患者都有儿童创伤史，可能使治疗复杂化。

MFT offers a safe space to address these issues and integrates trauma-informed care into the therapeutic process. Managing Psychiatric Comorbidities: MFT helps in identifying and managing co-occurring psychiatric disorders, ensuring a comprehensive approach to mental health care. Building Resilience and Coping Skills: Through shared experiences and mutual support, families can develop greater resilience and improved coping mechanisms to better manage the challenges of DTD.Unfortunately, current limitations include the lack of large-scale randomized clinical trials, which makes it difficult to generalize the results obtained in smaller clinical settings.

MFT为解决这些问题提供了一个安全的空间，并将创伤知情护理纳入治疗过程。管理精神病合并症：MFT有助于识别和管理共同发生的精神疾病，确保全面的精神卫生保健方法。建立复原力和应对技能：通过分享经验和相互支持，家庭可以发展更大的复原力和改进的应对机制，以更好地管理DTD的挑战。不幸的是，目前的局限性包括缺乏大规模的随机临床试验，这使得难以概括在较小的临床环境中获得的结果。

Furthermore, it would be advisable to design longitudinal studies to evaluate the long-term effects of MFT, including in patients with DTD. Suggested methodologies for future studies should incorporate neuroimaging techniques to observe brain changes associated with MFT, along with more sophisticated measures to assess psychological and social outcomes of treatment.

此外，建议设计纵向研究来评估MFT的长期影响，包括DTD患者。未来研究的建议方法应纳入神经影像学技术，以观察与MFT相关的大脑变化，以及评估治疗心理和社会结果的更复杂措施。

I believe that these lines of research can provide new insights into the mechanism.

我相信这些研究可以为该机制提供新的见解。

DTD presents a complex therapeutic challenge that necessitates an integrated and multidimensional approach. In recent years, the growing focus on DTD has led to a redefinition of the concept of treatment-resistant depression, shifting the emphasis from a sole focus on lack of response to pharmacotherapy to a broader perspective that also considers the psychological, social, and environmental dynamics of patients.

DTD提出了一个复杂的治疗挑战，需要采用综合和多维的方法。近年来，对DTD的日益关注导致了对难治性抑郁症概念的重新定义，将重点从单纯关注对药物治疗缺乏反应转移到更广泛的角度，也考虑了患者的心理，社会和环境动态。

In this context, MFT may emerge as a promising intervention capable of addressing the multiple facets of DTD through the active involvement of families in the therapeutic process. The integration of MFT in the treatment of DTD may constitute a significant innovation compared to other therapeutic approaches.

在这种情况下，MFT可能会成为一种有前途的干预措施，能够通过家庭积极参与治疗过程来解决DTD的多个方面。与其他治疗方法相比，MFT在DTD治疗中的整合可能构成重大创新。

It not only aims to reduce depressive symptoms but also seeks to improve the patient's overall functioning, including social and emotional aspects, which is another key goal in the care of DTD. By involving families in the care process, MFT promotes greater adherence to treatment, reduces relapse rates, and provides continuous supportcritical elements for patients with DTD.

它不仅旨在减少抑郁症状，还旨在改善患者的整体功能，包括社交和情绪方面，这是DTD护理的另一个关键目标。通过让家庭参与护理过程，MFT促进了对治疗的更大依从性，降低了复发率，并为DTD患者提供了持续的支持关键因素。

The complexity of DTD often includes childhood trauma, psychiatric comorbidities, and a history of treatment failures, requires targeted interventions that go beyond conventional pharmacological therapies. In this sense, MFT offers a unique opportunity to address these issues in an integrated manner.

DTD的复杂性通常包括儿童创伤，精神病合并症和治疗失败史，需要超越常规药物治疗的有针对性的干预措施。从这个意义上说，MFT为以综合方式解决这些问题提供了独特的机会。

MFT does not exclude the concomitant practice of other individual psychotherapies, such as the Cognitive Behavioral Analysis System of Psychotherapy, Mindfulness-Based Cognitive Therapy, and Schema Therapy, which have been shown to be effective in the management of DTD. Rather, it offers benefits not only by strengthening the individual psychotherapeutic intervention but also by positively im.

MFT不排除其他个体心理治疗的伴随实践，例如心理治疗的认知行为分析系统，基于正念的认知治疗和图式治疗，这些治疗已被证明对DTD的管理有效。相反，它不仅通过加强个体心理治疗干预，而且通过积极的im提供益处。