认知-行为疗法对偏头痛患者状态焦虑的影响

Clinical study on cognitive-behavioral therapy for migraine patients

目的探讨认知-行为治疗对偏头痛患者状态焦虑的影响。方法53例符合国际头痛协会关于偏头痛的诊断标准的偏头痛患者分为对照组27例、观察组26例,50例同龄健康青年作为健康组。对照组：吲哚美辛25-50 mg,3次/d,心得安30-80 mg,3次/d,丙戊酸镁0.2,3次/d;观察组：药物治疗同对照组并予以认知-行为治疗,2组均治疗6个月。所有患者于治疗前、治疗6个月、治疗结束6个月分别行偏头痛诊断疗效评分、应对方式问卷（CSQ）、状态-特质焦虑问卷（ST-AI）进行评分。结果2组患者、健康组S-AI总分、自责因子分分别是（45.06±7.38）分vs（36.56±6.29）分、（0.79±0.25）分vs（0.38±0.26）分,而解决问题、求助因子分显著低于健康组,差异有非常显著性（P〈0.01）;治疗6个月,观察组S-AI总分显著下降（P〈0.01）;治疗结束6个月,对照组与观察组头痛持续时间、S-AI、自责因子分分别是（9.48±3.06）分vs（5.24±3.66）分,（43.58±7.38）分vs（37.27±8.04）分,（0.72±0.32）分vs（0.50±0.23）分,P〈0.01。结论偏头痛患者心理健康状况较差、焦虑程度高,常常使用不成熟的应对方式;认知-行为治疗对改善患者思维方式、降低焦虑程度、提高患者应对技巧、减少偏头痛发作疗效显著。

Objective To explore the effect of cognitive-behavioral therapy（CBT） on in state-anxiety for migraine patients. Methods 53 migraine patients were divided into control group （ n=27 ） and observation group （ n=26 ）. 50 health people were as the health group. For control group：taken orally indometacin, 25 50mg,3/d, magnesium valproate 0.2 3/d and propranolo 30 -80 mg 3/d. For observation group： CBT besides pharmacal therapy. Every patient was treated for six months. Both groups were examined respectively in pre-therapy, post-therapy with the therapeutic scale score on migraine （TSSM） , State-Trait Anxiety Inventory（ST-AI） and Coping Style Questionnaire（CSQ） , and six months after therapy were stopped. Results The average score of SAI ,self-blame score of the two group patients and health people was respectively （45.06 ± 7.38 vs 36.56 ± 6.29, 0.79 ± 0.25 vs 0.38 ± 0.26） , however, the problem-solving and resort score was much lower in migraine patients, which was of remarkably significant （ P〈 0.01 ）. The S-AI score of observation group after post-therapy was significantly reduced （ P〈 0.01 ）. Six months after treatment stopped, the average persistence time of headache , S-AI, self-blame score of CSQ between the two group patients was respectively （9.48 ± 3.06 vs 5.24 ± 3.66, 43.58 ±7.38 vs 37.27 ±8.04,0.72 ±0.32 vs 0.50 ±0.23, P〈0.01 ）. Conclusion The migraine patients have lower psychological health standard, higher anxiety level and often take immature coping style facing difficulty and frustration. The CBT can improve the cognitive disfunction and coping style of the migraine patients, which can also reduce the anxiety level and the times of headache attacking.