首页|认知行为治疗联合家庭干预对强迫症的疗效研究

认知行为治疗联合家庭干预对强迫症的疗效研究

扫码查看
目的 探讨联合家庭干预的认知行为治疗(cognitive behavioral therapy,CBT)对强迫症的疗效.方法 选择2021年6月至2022年6月在厦门市仙岳医院门诊就诊的强迫症患者28例,采用随机数字表法分为干预组(n=13)和对照组(n=15).干预组和对照组均进行常规药物治疗,在此基础上,干预组实行CBT联合家庭干预治疗,对照组仅针对患者进行CBT治疗.分别在基线、干预结束后、结束后1个月和3个月,采用耶鲁.布朗强迫症状量表(Yale-Brown obsessive compulsive scale,Y-BOCS)评估患者的症状严重程度,席汉氏残疾量表(Sheehan disability scale,SDS)评估患者的功能损害情况,强迫症家庭顺应行为量表调查员评定版(family accommodation scale for OCD interviewer-ra-ted,FAS-IR)评估家属的家庭顺应行为发生情况.以Y-BOCS量表、SDS量表和FAS-IR量表分数在每个观察时间点上的分数变化为结局指标.使用SPSS 25.0软件,对数据进行t检验、x2检验、重复测量方差分析.结果 (1)干预组和对照组干预前后Y-BOCS评分时间与分组交互效应显著(F=4.748,P<0.05).简单效应检验结果显示,干预组干预结束后1个月Y-BOCS评分[(20.63±5.23)分]低于基线期[(27.23±5.12)分]和干预结束后[(24.85±5.94)分](均P<0.05),干预结束后3个月Y-BOCS评分[(16.85±4.62)分]低于基线期、干预结束后和干预结束后1个月(均P<0.05);对照组干预结束后3个月Y-BOCS评分[(20.93±7.51)分]低于基线期[(25.93±4.68)分]、干预结束后[(25.53±6.57)分](均P<0.05).(2)干预组和对照组干预前后SDS评分时间与分组交互效应显著(F=54.88,P<0.01).简单效应检验结果显示,干预组干预结束后SDS评分低于基线期(P<0.05),干预结束后1个月SDS评分低于基线期和干预结束后(均P<0.05),干预结束后3个月SDS评分低于基线期、干预结束后和干预结束后1个月(均P<0.05);干预结束后3个月干预组的SDS评分水平低于对照组(P<0.05).(3)干预组和对照组干预前后FAS-IR评分时间与分组交互效应显著(F=20.285,P<0.01).简单效应检验结果显示,干预组干预结束后FAS-IR评分低于基线期(P<0.05),干预结束后1个月FAS-IR评分低于基线期和干预结束后(均P<0.05),干预结束后3个月FAS-IR评分低于基线期、干预结束后和干预结束后1个月(均P<0.05).干预结束后3个月,干预组的FAS-IR评分水平低于对照组(P<0.05).结论 CBT治疗联合家庭干预有助于提高强迫症治疗效果,改善患者的功能损害和降低家庭顺应行为的发生,为强迫症的家庭干预提供依据.
The therapeutic effect of cognitive behavioral therapy combined with family intervention on obsess-ive-compulsive disorder
Objective To explore the therapeutic effect of cognitive behavioral therapy(CBT)combined with family intervention on obsessive-compulsive disorder(OCD).Method A total of 28 pa-tients with OCD who visited the outpatient department of Xiamen Xianyue Hospital from June 2021 to June 2022 were randomly divided into intervention group(n=13)and control group(n=15).Patients in the inter-vention group and the control group were both received routine drug treatment.On this basis,the patients in intervention group received the treatment of CBT combined with family intervention,while the patients in con-trol group only received CBT treatment.The participants were evaluated at baseline,post-intervention,1 month and 3 months after the intervention.The Yale-Brown obsessive compulsive scale(Y-BOCS)was used to evaluate the severity of symptoms,and the Sheehan disability scale(SDS)was used to assess their func-tion impairment in patients.The family accommodation scale for OCD interviewer-rated(FAS-IR)was em-ployed to assess family members'family accommodation behavior.Changes in scores on the Y-BOCS scale,SDS scale,and FAS-IR scale scores at each observation time point were used as outcome indicators.The t-test,x2-test and repeated measure ANOVA were used for statistical analysis by SPSS 25.0 software.Re-sults(1)The interaction effect of Y-BOCS score between time and group before and after intervention was significant(F=4.748,P<0.05).The results of the simple effects test showed that the Y-BOCS score of the intervention group at 1 month after the intervention(20.63±5.23)was lower than that of the baseline(27.23±5.12)and post-intervention(24.85±5.94)(both P<0.05).The Y-BOCS score of the intervention group at 3 months after the intervention(16.85±4.62)was lower than that of the baseline,post-intervention,and 1 month after the intervention(all P<0.05).The Y-BOCS score of the control group at 3 months after the intervention(20.93±7.51)was lower than that of the baseline(25.93±4.68)and post-intervention(25.53±6.57)(both P<0.05).(2)The interaction effect of SDS score between time and group before and after intervention was significant(F=54.88,P<0.01).The results of the simple effects test showed that the SDS score of the intervention group at post-intervention was lower than that of the baseline(P<0.05).The SDS score at 1 month after the intervention was lower than that of the baseline and post-intervention(both P<0.05).The SDS score of the intervention group at 3 months after the intervention was lower than that of the baseline,post-intervention,and 1 month after the intervention(all P<0.05).At 3 months after the inter-vention,the SDS score of the intervention group was lower than that of the control group(P<0.05).(3)The interaction effect of FAS-IR score between time and group before and after intervention was significant(F=20.285,P<0.01).The results of the simple effects test showed that post-intervention,the FAS-IR score of the intervention group was lower than that of the baseline(P<0.05).The SDS score at 1 month after the in-tervention was lower than the baseline and post-intervention(both P<0.05).The FAS-IR score of the inter-vention group at 3 months after the intervention was lower than that of the baseline,post-intervention,and 1 month after the intervention(all P<0.05).At 3 months after the intervention,the FAS-IR score of the inter-vention group was lower than that of the control group(P<0.05).Conclusion The CBT combined with family intervention can improve the treatment outcome of OCD,patients'functional impairment,and reduce the occurrence of family accommodation behavior,which providing a basis for family intervention in OCD.

Obsessive-compulsive disorderFamily interventionCognitive behavioral therapyTherapeutic effect

陈莹、聂小伟、丁丽君

展开 >

厦门市仙岳医院强迫症与认知行为治疗科,厦门医学院附属仙岳医院,福建省精神医学中心,福建省精神疾病临床医学研究中心,厦门 361012

强迫症 家庭干预 认知行为治疗 疗效

厦门市医疗卫生指导性项目

3502Z20209249

2024

中华行为医学与脑科学杂志
中华医学会 济宁医学院

中华行为医学与脑科学杂志

CSTPCD北大核心
影响因子:1.472
ISSN:1674-6554
年,卷(期):2024.33(6)