网络认知行为疗法干预医学生社交焦虑状态的初步研究

A preliminary study of internet-based cognitive behavior therapy intervent medical university students＇ social anxiety

目的探讨网络认知行为疗法（ICBT）干预对医学生社交焦虑状态的干预效果，为今后社交焦虑干预治疗提供经验和理论基础。方法45名社交焦虑的医学生，采用自愿分组方式分成3组，即对照组、一对一网络干预组、一对五网络干预组。其中对照组未干预，一对一网络干预组和一对五网络干预组分别是采取以认知行为疗法为主的单人和团体治疗干预方法的实验组。于干预前后利用社交焦虑问卷和社交焦虑状态访谈问卷分别对各组学生社交焦虑水平和状态进行评估。结果干预后一对一网络干预组、一对五网络干预组社交焦虑总分和各因子分分别低于对照组（社交焦虑总分：一对一组（15．60±7．87）分，一对五组（14．87±8．83）分，对照组（20．20±11．46）分，3组之间方差分析显示，除生理反应因子外，SPIN总分、害怕和回避因子差异均具有显著性（F=0．641，P=0．806；F=3．764，P=0．018；F=3．606，P=0．021；F=5．444，P=0．005）。参与者社交焦虑状态分析中，一对一ICBT组的2名临床状态参与者1名转为亚临床状态，1名转为正常，3名亚临床状态全部转为正常，参与人员社交焦虑状态均有明显改善；一对五ICBT组中，1名社交焦虑临床状态参与者转为亚临床状态，1名亚临床状态参与者维持原状态不变，2名亚健康状态参与者全部转为正常；对照组无变化。结论两种网络干预方法对降低社交焦虑水平均有一定疗效，一对一网络干预疗法效果最为显著。

Objective To analyze the internet-based cognitive behavior therapy （ICBT） intervent medical university students＂ social anxiety, and provide experiences and theoretical basis for future social anxiety interventions. Methods 45 medical students of social anxiety were voluntarily divided into the one-to-one intervention group, one-to-five intervention group and control group. The control group did not intervene, one-to-one intervention group and one-to-five intervention group were interfered single person or team by cognitive behavioral therapy, re- spectively. The level and symptom of social anxiety of the 3 groups were assessed before and after the intervention by social phobia inventory（SPIN） and Social anxiety symptoms interview inventory. Results After the interven- tion, the scores of SPIN and the 3 subscales within it （fear, avoidance and physiological） of one-to-one ICBT group and one-to-five ICBT group were lower than those of the control group （SPIN scores：one-to-one ICBT group 15.60 -＋ 7.87,one-to-five ICBT group 14.87 _＋ 8.83, control group 20.20 ＋ 11.46）. Variance analysis showed that, in addition to physiological subscale （F = 0.641, P 〉 0.05 ） , the scores of SPIN, fear and avoidance subscales had sig- nificant differences among the 3 groups （F = 3. 764, P = 0.018 ; F= 3. 606, P = 0. 021 ; F= 5. 444, P = 0. 005 ）. In the analysis of participants＂ social anxiety symptoms, after treatment,in one-to-one ICBT group, there was 1 partici- pant changed into subthreshold social anxiety and 1 participant into normal in the 2 threshold social anxiety partici- pants. All the 3 subthreshold social anxiety participants changed into normal. In one-to-five ICBT group,there was 1 threshold social anxiety participant lapsed to subthreshold social anxiety, 1 subthreshold social anxiety partici- pants still remained in subthreshold social anxiety ,2 symptomatic social anxiety participants changed into normal. But there were no significant changes in control group. Conclusions All the two methods of intervention have a certain effect. The effect of one-to-one intervention therapy is most significant.