Rufer Michael, Hand Iver, Braatz Anne, Alsleben Heike, Fricke Susanne, Peter Helmut
University Hospital of Hamburg, Centre of Psychosocial Medicine, Department of Psychiatry and Psychotherapy, Hamburg, Germany.
Psychother Psychosom. 2004 Mar-Apr;73(2):101-6. doi: 10.1159/000075541.
Alexithymia as a predictor of treatment outcome in psychotherapy has often been discussed but rarely evaluated in prospective studies. The present study evaluated the absolute and relative stability of alexithymia in patients with obsessive-compulsive disorder (OCD), and the predictive value of alexithymia for the outcome of treatment.
We conducted a prospective study with 42 inpatients receiving intensive, multimodal cognitive-behavioral therapy (CBT). Patients were assessed for alexithymia at pre- and post-treatment with the 20-item Toronto Alexithymia Scale (TAS-20), for obsessive-compulsive symptoms and depression with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the 21-item Hamilton Depression Rating Scale (HDRS).
OCD and comorbid depression showed a highly significant symptom-reduction from pre- to post-treatment while no absolute changes in the TAS-20 total scores and its factors 1 and 3 occurred. Only factor 2 scores decreased significantly, but with a smaller effect size than the effect sizes for the changes in Y-BOCS and HDRS. Alexithymia scores at pre-treatment correlated significantly with alexithymia scores at the end of treatment, indicating its relative stability. In the linear regression analyses, no variables were identified that predicted significantly the outcome of treatment.
Our findings support the view that alexithymia is a stable personality trait rather than a state-dependent phenomenon in obsessive-compulsive patients. Alexithymia scores do not predict response to multimodal CBT in OCD. It might be an effect of CBT that patients could at least partly regain or newly learn the capability to describe their feelings.
述情障碍作为心理治疗中治疗结果的预测指标经常被讨论，但在前瞻性研究中很少被评估。本研究评估了强迫症（OCD）患者述情障碍的绝对稳定性和相对稳定性，以及述情障碍对治疗结果的预测价值。
我们对42名接受强化多模式认知行为疗法（CBT）的住院患者进行了一项前瞻性研究。使用20项多伦多述情障碍量表（TAS-20）在治疗前和治疗后对患者的述情障碍进行评估，使用耶鲁-布朗强迫症量表（Y-BOCS）和21项汉密尔顿抑郁量表（HDRS）对强迫症状和抑郁进行评估。
从治疗前到治疗后，强迫症和共病抑郁的症状有非常显著的减轻，而TAS-20总分及其因子1和因子3没有绝对变化。只有因子2得分显著下降，但效应量小于Y-BOCS和HDRS变化的效应量。治疗前的述情障碍得分与治疗结束时的述情障碍得分显著相关，表明其相对稳定性。在线性回归分析中，没有发现能显著预测治疗结果的变量。
我们的研究结果支持这样一种观点，即述情障碍在强迫症患者中是一种稳定的人格特质，而不是一种依赖状态的现象。述情障碍得分不能预测强迫症患者对多模式CBT的反应。患者至少可以部分恢复或新学会描述自己感受的能力，这可能是CBT的一个效果。
