强迫症团体认知行为治疗与药物治疗的随机对照研究

A randomized controlled trial of group cognitive-behavioral therapy and medication treatment for obsessive-compulsive disorder

目的分析团体认知行为治疗(group cognitive-behavioral therapy,GCBT)对强迫症患者的疗效。方法本研究采用随机对照试验设计,与常规抗强迫药物治疗做对照。将符合入组标准的94例未用药强迫症患者,采用Excel软件中的RAND函数产生随机数字表形成随机分组序列的简单随机分组法,随机分为GCBT组(47例)和药物治疗组(47例)。经12周的结构化GCBT治疗和常规抗强迫药物治疗,采用t检验、卡方检验和方差分析比较2组间Y-BOCS、HAMA14和HAMD24平均减分率和减分值的差异。结果(1)2组基线Y-BOCS及HAMA14评分差异无统计学意义(t=0.281,P=0.779;t=0.795,P=0.429),但GCBT组HAMD24评分显著低于药物治疗组(t=2.316,P<0.05)。2组各有16例患者退出治疗,总脱落率为34%(32/94)。(2)12周治疗结束时,2组患者的Y-BOCS评分较基线显著降低,GCBT组和药物治疗组治疗前后Y-BOCS平均减分率[(37.0±27.4)%比(45.5±22.9)%]和平均减分值[(9.0±6.3)分比(11.0±5.8)分]比较差异无统计学意义[F(1,62)=0.069,P=0.794;F(1,62)=0.001,P=0.975]。GCBT组和药物治疗组的有效率和治愈率差异无统计学意义(χ^2=1.653,P=0.199;χ^2=0.088,P=0.767)。(3)GCBT组HAMA14减分率和减分值与药物治疗组治疗前后比较差异无统计学意义(t=-0.922,P=0.362;t=1.082,P=0.286)。(4)GCBT组HAMD24减分率与药物治疗组治疗前后比较差异无统计学意义,但药物治疗组HAMD24减分值显著高于GCBT组(t=2.239,P=0.029)。结论GCBT与常规抗强迫药物治疗强迫症患者的强迫和焦虑症状的疗效相当,常规药物治疗对抑郁症状的疗效优于GCBT。

Objective To explore the therapeutic effect of group cognitive-behavioral therapy(GCBT)for obsessive-compulsive disorder(OCD).Methods This study used a randomized controlled trial design to compare GCBT with routine medication treatment.Unmedicated ninety-four patients who met the inclusion criteria were recruited and randomly allocated to GCBT group(n=47)and drug treatment group(n=47)by a simple random grouping method using the RAND function in Excel software which generated a table of random numbers to form a random grouping sequence.Both groups were treated for 12 weeks.The average reduction rate and value of Y-BOCS,HAMA14 and HAMD24 were compared between the two groups,t-test,chi-square(χ^2)test and variance analysis(ANOVA)were condulted to analyze data.Results(1)There was no significant difference between two groups in Y-BOCS and HAMA14 scores at baseline(t=0.281,P=0.779;t=0.795,P=0.429),but HAMD24 scores were significantly different(t=2.316,P<0.05).Sixteen patients in GCBT group and sixteen in drug treatment group dropped out of treatment,resulted a total drop-out rate of 34%.There was no significant difference in the drop-out rate between the two groups.(2)After 12-week treatment,the Y-BOCS scores decreased compared to pre-treatment in both groups.There was no statistical difference in the mean reduction rate((37.0±27.4)%vs.(45.5±22.9)%)and score(9.0±6.3 vs.11.0±5.8)of Y-BOCS(F(1,62)=0.069,P=0.794;F(1,62)=0.001,P=0.975)before and after treatment between the two groups.There was no statistical difference in the effective and cure rate between the two groups(χ^2=1.653,P=0.199;χ^2=0.088,P=0.767).(3)There was no significant difference in the mean reduction rate and score of HAMA14(t=-0.922,P=0.362;t=1.082,P=0.286).(4)No significant difference was found regarding the mean reduction rate of HAMD24 between the two groups,but the mean reduction scores of HAMD24 in the medication group were significantly higher than those in GCBT group(t=2.239,P=0.029).Conclusion GCBT is equivalent to conventional medication treatment for obsessive-compulsive and anxiety symptoms for OCD patients,and medication treatment is superior to GCBT in depressive symptoms.