认知行为治疗联合注意力训练对精神分裂症幻听干预效果的随机对照试验

A randomized controlled trial of cognitive behavioral therapy combined with attention training technique on auditory hallucinations of schizophrenia

目的:评价认知行为治疗(CBT)联合注意力训练技术(ATT)对精神分裂症患者幻听的干预效果。方法:选取符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)精神分裂症的诊断标准且有幻听症状的患者60例,随机分为CBT组30例(26例完成)和CBT+ATT组30例(25例完成)。CBT组只接受4周的幻听认知行为干预,CBT+ATT组在幻听认知行为基础上增加注意力训练技术干预共6周。在基线及12周后,采用精神症状评定量表-幻听分量表(PSYRATS-AH)和住院精神病人社会功能评定量表(SSPI)评估两组患者的幻听症状及社会功能,采用注意控制量表(ACS)评估CBT+ATT组患者的注意控制能力。结果:12周后,CBT+ATT组PSYRATS-AH总分[(-6.8±2.2)vs.(-4.2±1.5)]及幻听频率、持续时间、痛苦数量、对声音的控制的差值(干预后得分-基线得分)均低于CBT组(均P<0.05),CBT+ATT组SSPI总分[(13.9±2.9)vs.(11.6±4.2)]及因子I、因子III的差值均高于CBT组(均P<0.05)。结论:本研究显示认知行为治疗联合注意力训练可更有效地改善精神分裂症患者的幻听症状和社会功能。

Objective:To evaluate the effects of cognitive behavior therapy(CBT)combined with attention training technique(ATT)on auditory hallucinations of schizophrenia.Methods:Sixty schizophrenia patients with auditory hallucinations were recruited according to the criteria of International Classification of Diseases,tenth Edition(ICD-10).They were randomly divided into the CBT group(30 cases,26 cases completed)and the CBT+ATT group(30 cases,25 cases completed).The CBT group received only 4 weeks of cognitive behavioral intervention for auditory hallucinations,and the CBT+ATT group received 6 weeks of attention training technology intervention based on cognitive behavioral intervention.At baseline and after 12 weeks,the Psychotic Symptom Rating Scales-Auditory Hallucinations(PSYRATS-AH)and Scale of Social function in Psychosis Inpatients(SSPI)were used to evaluate the auditory hallucinations symptoms and social functioning of the two groups,and the Attentional Control Scale(ACS)was used to evaluate patients′attentional control ability of the CBT+ATT group.Results:After 12 weeks,the differences(post intervention score-baseline score)of PSYRATS-AH total scores[(-6.8±2.2)vs.(-4.2±1.5)],auditory hallucinations′frequency,duration,number of distresses,control of voices were lower in the CBT+ATT group than in the CBT group(Ps<0.05),and the differences of the SSPI total scores[(13.9±2.9)vs.(11.6±4.2)]and scores of Factor I and Factor III were higher in the CBT+ATT group than in the CBT group(Ps<0.05).Conclusion:This study shows cognitive behavioral therapy combined with attention training technique could improve auditory hallucinations and social function more effectively in patients with schizophrenia.