认知暴露疗法治疗震后急性应激障碍临床观察

Effects of cognitive exposure therapy on acute stress disorder after earthquake

目的探讨集中实施认知暴露疗法(Cognitive Exposure Therapy,CET)对汶川震后成人急性应激障碍(Acute Stress Disorder,ASD)的治疗效果.方法整群抽样绵竹市某安置区142例成人ASD患者,随机分为心理疏导组(A组)、药物治疗组(B组)和对照组(C组),分别予集中CET、药物治疗和常规心理健康教育处置,采用症状自评量表(Symptom Checklist 90,SCL-90)、明尼苏达多项人格测验-2附加量表PK(Minnesota Multiphasic Personality Inventory-PK,MMPI-PK)评价干预前后患者心理健康水平和ASD症状严重程度的变化.结果干预前,三组间心理测评评分和测评异常率的差异不显著(P>0.05).干预后,各组SCL—90总分、PK分、测评异常率均较干预前显著降低(P<0.05),除寝食状态因子、C组躯体化和焦虑因子外,各组其余SCL-90因子均较干预前显著降低(P<0.05).干预后,SCL-90总分、PK分、测评异常率,A组显著低于B组和C组(P<0.05),减量值(△)显著高于B组和C组(P<0.05),B、C两组间无论三项指标值,还是相应△的差异则均不显著(P>0.05);因子评分,寝食状态及其△在三组间未显示有统计意义的差异(P>0.05),躯体化、焦虑因子及其△在A、B两组间的差异不明显(P>0.05),但两因子评分均显著低于C组(P<0.05),△均高于C组(P<0.05),其余因子A组均显著低于B组和C组(P<0.05),相应△则均显著高于B组和C组(P<0.05),B、C两组间的差异则均不显著(P>0.05).结论集中实施CET能够有效改善震后批量ASD患者的症状和心理健康水平,适宜震后应急心理救援使用.

Objective To explore the effect of centralized implementation of cognitive exposure therapy (CET) on patients with acute stress disorder (ASD) after Werdhuan Earthquake. Method 142 ASD patients, aged 17~71, with the education level of junior high school and below, in a resettlement area of Mianzhu, were randomly divided into 3 groups by cluster sampling: Group A (n=49) undergoing CET by psychological guidance specialists every 3 days for 5 times, Group B(n=46) taking Propranolol 25 mg/d etc for 15 days, and Group C(n=47) undergoing conventional psychologi. cal counseling by the mobile medical team every 3 days for 5 times. Symptom Checklist 90 (SCL-90) and Minneso. ta Multiphasic Personality Inventory-2 affiliated Keane's scale (MMPI-PK) were employed to evaluate the mental health and symptom severity within one week before and after the treatment. Results Before treatment, neither psychological scores nor abnormity rates of evaluation were different significantly among the three groups (P > 0.05). After treatment, the SCL-90 total scores, PK scores and abnormity rates of evaluation of the 3 group all reduced significantly (P < 0.05). Except the factor of sleeping and eating, somatization and anxiety in Group C, other SCL.90 factors of the 3 groups all reduced significantly (P < 0.05). After treatment, the SCL-90 total score, PK score, and abnormity rate of evaluation of Group A were all significantly lower than those of both Group B and Group C (P<0.05), and the decrements (△) of the 3 indicators were all significantly higher than those of Groups B and C ( P < 0.05), whereas between Groups B and C, all these differences were not significant (P > 0.05). There were no significant differences in the scores of sleeping and eating factor and their decrements (△) among the 3 groups (P > 0.05). There were no significant differences in somatization, anxiety and their decrements(△) between Group A and Group B (P > 0.05), but the scores of these 2 factors in Group A and Group B were both significantly lower than those of Group C (P < 0.05) with their decrements (△) higher than those of Group C significantly (P < 0.05). The rest factors behaved similarly: the scores in Group A were all significantly lower than those in Groups B and C (P < 0.05) with their decrements (△) all higher than those in Groups B and C significantly (P < 0.05), whereas between B and C none of the differences was significant (P>0.05). Conclusion Improving effectively the symptoms and mental health of mass ASD after earthquake, centralized implementation of CET is suitable for psychological emergency rescue after earthquake.