集体认知行为治疗对广泛性焦虑障碍疗效的随机对照研究

Group cognitive-behavioral therapy for generalized anxiety disorder:A randomized controlled trial

目的:探索集体认知行为治疗对广泛性焦虑障碍的临床疗效。方法:采用随机对照研究,最终纳入对照组(n=25)与干预组(n=33),两组均服用度洛西汀30~120 mg治疗。干预组除药物外,接受集体认知行为治疗,每周1次,每次90 min,共8次。采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、临床评估量表(CGI)在基线、第4周及第8周进行评估。CGI包括病情严重程度(SI)、疗效总评(GI)和疗效指数(EI)3个条目。结果:HAMA评分的重复测量方差分析结果显示,测量时间与分组处理的交互作用有统计学意义(F=4.35,P<0.05)。干预组HAMA第4周及第8周的相对于基线的减分值大于对照组,而第4周的痊愈率及有效率高于对照组;在第8周测评点时,干预组HAMD相对于基线的减分值大于对照组,而CGI-SI与CGI-EI评分低于对照组。结论:与单独的药物治疗相比,在药物治疗基础上结合集体认知行为治疗能够早期起效,更为显著地改善广泛性焦虑障碍患者的焦虑症状、抑郁症状和总体病情。

Objective： To explore the efficacy of group cognitive-behavioral therapy （GCBT） to generalized anxiety disorder （GAD）. Methods： In this randomized controlled trial, the control group （n = 23） and the intervention group （n = 33） were included, all of the participants received duloxetine （30 - 120 mg/d） as pharmacotherapy. The intervention group received 8 group cognitive-behavioral therapy sessions weekly, 90 minutes for each time. Assessments were conducted with the Hamilton Anxiety Scale （HAMA）, Hamilton Depression Scale （HMAD） and Clinical Global Impression （CGI） at baseline, mid-treatmentand post-treatment. CGI included three factors, the severity of illness （SI）, the globalimprovement （GI） and the efficacy index （EI）. Results： The repeated measures analysis of variance of HAMA showed that, there were statistical significance on the HAMA for interaction between measure time and group processing （F =4. 35, P 〈0. 05）. Compared with the control group, the inter- vention group got higher decreased scores of HAMA at the 4th week and 8th week, and higher prevalence of being cured and efficient at the 4th week. At the 8th week, the decreased scores of HMAD were higher in the intervention group than in the control group, and the scores of CGI-SI and the CGI-IE were lower in the intervention group. Conclusion： It suggests that group cognitive-behavioral therapy combined with pharmacotherapy could be earlier to be effective, and the symptoms of anxiety, depression and the state of illness could be improved more significantly compared with pharmacotherapy alone.