认知暴露疗法治疗急性应激障碍的临床对照研究

Case-control study of cognitive exposure therapy of acute stress disorder

目的 :探讨认知暴露疗法对急性应激障碍患者的治疗效果 ,并比较心理治疗和药物治疗的疗效差别 ,为运用心理疗法治疗急性应激障碍提供实验依据 .方法 :连续病例 6 3例 ,分成心理治疗组 (A组 )和药物治疗组 (B组 ) ,心理治疗组采用结构化的认知暴露疗法 .疗效评定采用SCL 90、BDI、HAMD、STAI和HAMA .结果 :在治疗前所有患者SCL 90总分及其各分因子分、BDI、HAMD、STAI、HAMA总分均显著高于治疗后得分 ;心理治疗组的时间显著长于药物治疗组 ;药物治疗组SCL 90总分和躯体化、强迫、焦虑 3项症状较心理治疗组改善更明显 (P <0 0 1) ;而抑郁、恐怖两项症状心理治疗组较药物治疗组改善明显 (P <0 0 5 ) ;精神病性和STAI得分药物治疗组较心理治疗组下降幅度更大 (P <0 0 5 ) ;HAMA、HAMD、BDI分数两组间无明显差异 .结论 :结构化认知行为疗法对ASD患者有效 ,在许多指标上都能达到药物治疗的效果 ,而药物治疗的短期效果更明显 .

AIM: To investigate the effect of the cognitive behavioral therapy in treating the acute stress disorder (ASD) and to compare the effect of treating the acute stress disorder with medication and with psychotherapy. METHODS: Sixty-three continuous patients with acute stress disorder were collected and divided into group A (psychotherapy) and group B (medication). The cognitive exposure therapy was used in treating group A. The curative effect was rated with SCL-90, Beck Depression Inventory (BDI), Hamilton Depression Scale (HAMD), State-Trait Anxiety Inventory (STAI) and Hamilton Anxiety Scale (HAMA). RESULTS: The scores of SCL-90, BDI, HAMD, STAI and HAMA before treatment were significantly higher than the scores after treatment. The treating time of group B was significantly shorter than group A and the total scores of SCL-90, somatization, obsessive-compulsive and anxiety in group B reduced more significantly than those of group A(P<0.01),while depression and phobic-anxiety were better alleviated in group A than in group B(P<0.05).There was no significant difference in the scores of HAMA, HAMD and BDI between the two groups. CONCLUSION: Cognitive behavioral therapy is effective for ASD patients and has the same effect in many aspects, but medication may have more obvious short-term effect.