认知暴露治疗对创伤后应激障碍患者自我评价和心率、血压的影响

The change of self-ratings and physiological index of post-traumatic stress disorder patients treated by cognitive-exposure therapy

目的探讨认知暴露治疗对创伤后应激障碍病人自我评价和心率、血压的影响。方法20名病例随机分为2组，一组采取药物治疗，另一组采取认知暴露疗法结合药物干预，利用病人的自我焦虑、自我抑郁和自我恐惧的变化，以及血压、心率作为追踪和评价疗效的指标。3个月后随访创伤后应激障碍症状清单量表评定。结果2组病人治疗后心率均有所下降，药物组随访时有所回升[结合治疗组：治疗前（74．00±2．96）次／min，治疗3个月后（75．2±0．98）次／min；药物治疗组：治疗前（73．30±2．96）次／min，治疗3个月后（71．30±0．98）次／min]。自我评价2组间没有发现显著差异，但纵向比较有显著差异且2组间存在交互效应（P〈0．01）。随访时结合治疗组有2人已经不符合创伤后应激障碍诊断（P〉0．05）。结论认知暴露治疗一定程度上可以促进创伤后应激障碍的心理康复，自我评价作为评价指标可以让病人更有效地参加治疗。

Objective To study the change of self-ratings and physiological index of post-traumatic stress disorder（PTSD） patients treated by cognitive-exposure therapy. Methods 20 continuous patients were divided randomly into two groups. One group were treated by medication, while the other group were treated by cognitive- exposure therapy and medication, and the effect was tested by the self-ratings and physiological index including blood pressure and heart rate. After three months, the continuance effect was rated by Post-traumatic Stress Disorder Checklist Scale. Results There was significant decline and a bit rise on the heart rate of both groups （ t = 2. 568, P〈0.05 ）. No significant discrimination was found between self-ratings of groups and there was significant discrimination at longitudinal level and significant inter-effect between groups （ F = 4. 869,3. 973,4. 248, P 〈 0.01 ）. At three moths visit there were two patients in combined group which were accorded with the diagnosis of PTSD （ Χ^2 = 2. 222, P〉 0.05 ）. Conclusion Cognitive-exposure therapy helps to mental recuperation of PTSD patients. Self-ratings skill make patients join the treatment effectively.