认知行为疗法与森田疗法整合应用治疗躯体形式障碍对照研究

A controlled trial of conbination of Cognitive Behavioral and Morita(CBMT)in Patients with Somatoform Disorders(SFD)

目的:研究认知行为疗法与森田疗法整合应用治疗躯体形式障碍的治疗效果,并探讨其对患者防御方式的影响。方法:将60例躯体形式障碍患者按住院先后顺序采用随机法分组,其中认知森田疗法组(研究组)30例,单用药物组(对照组)30例。两组患者均服用一般性药物治疗。治疗时间均为6周。于治疗前和治疗第1、2、4、6周末利用汉密尔顿抑郁量表(HAMD)、症状自评量表(SCL-90)躯体化因子分评估临床疗效,同时在治疗前和治疗第6周末进行防御方式量表(DSQ)调查,随访6个月及12个月观察两组患者服药的依从性和复发率。结果:两组患者治疗后第1、2、4、6周末HAMD和SCL-90躯体化因子评分较治疗前显著下降(P<0.05)。与治疗前相比,第6周末患者不成熟型和中间型防御机制评分降低,成熟型防御机制评分升高,差异均有统计学意义(P<0.05)。治疗6及12个月时研究组服药依从率显著高于对照组(χ2=5.10,7.70;P均<0.05);12月时复发率研究组显著低于对照组(χ2=7.70,P<0.01)。结论:认知疗法与森田疗法整合治疗躯体形式障碍疗效优于单用药物组;患者防御机制向成熟型转变;能提高远期服药的依从性,降低复发率。

Objective：To explore the efficacy and improvement of defense of Cognitive Behavioral and Morita thera- py（CBMT）in patients with Somatoform Disorders（SFD）.Methods：60 participants with a principle diagnosis of SFD were assigned randomly to the CBMT group（30）and the simple medical group（30）.Both groups were administrated with the same medication.The treatment period was 6 weeks. All patients were assessed with Hamilton Depression Scale （HAMD）, the somatization item of SCL--90 at baseline and at the end of lnd, 2th, 4th, 6thweek of treatment to evaluate the efficacy;defense styles were evaluated with Defense Style QueStionnaire（DSQ）in the baseline and treat- ment sixth weekend- The medication compliance and recurrence rates were observed with 6 and 12 months follow up. Results：Compared with the baseline, score of HAMD and factor score of somatization item of SCL-- 90 in both groups decreased significantly at the end of l nd, 2th, 4th, 6thweek of treatment（P〈0.05）. Mature defense in the sixth weekend were significantly higher than that before treatment（P〈0.05）.After 6 and 12 months follow up, the medication compliance rates in study group were significantly better than control group （χ^2= 5.10,7.70;all P 0.05）.The relapse rate was significantly lower in study group after 12 month（χ^2 =7.70 P〈0.01）.Conclusion：Combi- nation of Cognitive Behavioral and Morita（CBMT）in patients with Somatoform Disorders（SFD）have the effect of maturating defense,and its efficacy is superior to the simple medication, and it can increase medication compliance for long term, reduce the recurrence rate.