认知暴露疗法治疗门诊应激障碍病人和住院病人的疗效比较研究

Comparative Study on Effect of Cognitive Exposure Therapy between Inpatients of Stress Disorder and Outpatients

目的探讨门诊心理治疗和住院心理治疗在治疗应激障碍效果上的差异。方法连续病例33名随机分为两组,1组采取门诊心理治疗,另1组采取住院心理治疗,记录治疗时间,并且在治疗前后、治疗后3个月和1年4个时间点上测评汉密顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD),在后两个时间点上测评创伤后应激障碍症状清单量表和创伤后应激障碍量表(PTSD)的发病率。结果HAMA和HAMD在两组间差异不明显,在纵向时间轴上差异显著(F=47.896,76.552,P<0.01),1年随访时门诊组焦虑症状较3个月随访时改善明显(P<0.01);住院治疗时间明显长于门诊治疗时间(t=-2.149,P<0.05);门诊组创伤后应激障碍症状清单量表1年随访时明显低于3个月随访时(P<0.05);1年随访时住院组PTSD的患病率显著高于门诊组(χ2=5.543,P<0.05)。结论规范的门诊认知暴露疗法对于缓解应激障碍的症状,降低从急性应激障碍到PTSD的转化有着良好效果。

Objective To compare the curative effect of Cognitive Exposure Therapy between inpatients of stress disorder and outpatients. Methods A total of 33 continuous patients were divided randomly into two groups. One was treated by cognitive therapy at outpatient department, and the other was treated in hospital. The curative time was noted. HAMA and HAMD was tested at before-treatment, just after-treatment, 3 months after-treatment and 1year after-treatment. The Post-traumatic Stress Disorder Checklist Scale and incidence of a PTSD were measured at 3 months after-treatment and 1year after-treatment. Results There was no significant difference on HAMA and HAMD between groups, while significant differences were found among time points（F=47. 896,76. 552,P=0. 01）. The anxiety symptoms of outpatient group were more catabatic than inpatient group at 1year after-treatment （P〈0.01）. Curative time of inpatient group was significantly longer than that of outpatient group （t =-2. 149,P〈0.05）. Score of Post-traumatic Stress Disorder Checklist Scale of outpatient group at 1 year after-treatment were signifi- cantly lower than 3 months after-treatment（P〈0.05）. At 1year after-treatment,the incidence of PTSD of inpatients was significantly higher than that of outpatients（X^2= 5. 543,P〈0.05）. Conclusion Normative cognitive exposure therapy could treat the stress disorder and lower the incident of transformation from acute stress disorder to PTSD.