社交焦虑障碍与认知团体行为治疗疗效及预后的影响因素

Effects of Group Cognitive Behavioral Therapy on Social Anxiety Disorders

目的研究社交焦虑障碍(social anxiety disorder,SAD)患者的症状及其预后的影响因素,分析认知团体行为治疗(group cognitive-behavioral therapy,GCBT)的作用机制和长期效果。方法对50例SAD患者进行治疗前的心理问卷评估,包括社交焦虑量表(Liebowitz social anxiety scale,LSAS)、自动思维问卷(automatic thoughts questionnaire,ATQ)、惧怕否定量表(fear of negative evaluation questionnaire,FNE)、社会支持量表(social support rating scale,SSRS)、三维人格问卷(tridimensional personality questionnaire,TPQ)和父母教养方式问卷(egna minnen barndoms uppfostran,EMBU),评价患者的思维方式、人格特点及外界的心理社会支持等因素,并与50例健康对照对比;30例SAD患者进行GCBT治疗(采取以改善自我为主、合并部分认知行为治疗的团体心理治疗方案,每周1次,每次2h,共8周),在治疗后1周内再次进行量表、问卷调查,评价症状改善和认知改变程度。并对40例SAD患者(其中22例进行了GCBT治疗,18例未治疗)进行为期1~5年的随访。结果 SAD患者在思维方式、人格特点、社会支持、父母教养方式等方面与对照组比较差异有统计学意义(P<0.05)。GCBT治疗后社交焦虑(t=4.06,P=0.000)、负性思维(t=4.58,P=0.000)和惧怕否定(t=3.85,P=0.000)较治疗前明显减轻。随访发现SAD患者社交焦虑症状的减轻程度与患者的主观支持呈正相关(r=0.361,P=0.022),与父亲拒绝与否认的教育方式呈负相关(r=-0.431,P=0.005),参加治疗和未参加治疗的社交焦虑症状好转程度差异有统计学意义(P=0.033)。结论 GCBT治疗可通过改善SAD患者的负面认知缓解其症状,主观社会支持和父亲拒绝否定的教育方式会影响SAD患者的预后。

Objective To evaluate the effect of group cognitive behavioral therapy （GCBT） on social anxiety disorders （SAD）. Methods A total of 50 patients with SAD were recruited in this study. A survey containing the Liebowitz social anxiety scale （LSAS）, the automatic thoughts questionnaire （ATQ）, the fear of negative evaluation questionnaire （FNE）, the social support rating scale （SSRS）, the tridimensional personality questionnaire （TPQ）, and the egna minnen barndoms uppfostran （EMBU） was administered before and （one week） after the GCBT, including in the 50 healthy controls. About 21 patients completed the eight-week GCBT （once a week, 2 h a session）. Follow-up surveys were conducted on 40 patients （22 patients treated with GCBT and 18 untreated） over a 1-5 year period. Results Significant differences were found between the SAD patients and healthy controls in thinking mode, personality characteristics, social support, parental rearing styles, and social anxiety symptoms. Significant decrease in social anxiety symptom （ t=4.06, P=0.000）, negative automatic thoughts （ t=4.58, P=0.000） and fear for rejection （ t=3.85, P=0.000） were observed after the GCBT therapy. Such improvement was positively correlated with subjective social support （r=0.361, P=0.022）, and negatively correlated with rejection of father （r=-0.431, P=0.005）. There was also statistical difference between the patients with and without the GCBT therapy （ P=0.033）. Conclusion GCBT treatment can relieve SAD symptoms by changing the negative cognitive of SAD patients. Social support and rejection of father affects the prognosis of SAD.