Wald Jaye, Taylor Steven, Scamvougeras Anton
Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1 Canada.
Cogn Behav Ther. 2004;33(1):12-20. doi: 10.1080/16506070310005141.
Conversion disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition. There are several treatment options, although none has emerged as the treatment of choice. The present case study examined the effects of adding cognitive behaviour therapy to neuropsychiatric management of conversion disorder (motor subtype). The patient, a retired emergency services worker, presented with a history of intermittent episodes of speech disruption (inability to speak or difficulty speaking properly). Although episodes of speech disturbance sometimes occurred unexpectedly, they were more likely to occur under conditions of stress and fatigue, and were triggered by reminders of work-related traumatic events. The patient was treated with pharmacotherapy and psychoeducation from a neuropsychiatrist. With the aim of improving treatment outcome, cognitive behaviour therapy was added, involving imaginal exposure to trauma memories, along with cognitive restructuring. The frequency of between- and within-session speech disturbance episodes declined over the course of cognitive behaviour therapy to the point that the patient was essentially symptom-free. Within-session distress ratings also decreased, which suggested habituation to trauma-related memories. This case study demonstrates how particular cognitive behaviour therapy interventions can be usefully applied to one form of conversion disorder.
转换障碍由无法用一般医学状况解释的非自愿性感觉或运动症状及功能缺损组成。虽然没有一种治疗方法成为首选，但有几种治疗选择。本病例研究考察了在转换障碍（运动亚型）的神经精神科治疗中加入认知行为疗法的效果。该患者是一名退休的急救人员，有间歇性言语中断（无法说话或说话困难）病史。虽然言语障碍发作有时出乎意料，但在压力和疲劳情况下更易发生，且由与工作相关的创伤性事件的提示引发。该患者接受了神经精神科医生的药物治疗和心理教育。为提高治疗效果，加入了认知行为疗法，包括对创伤记忆的想象暴露以及认知重构。在认知行为疗法过程中，会话间和会话内言语障碍发作的频率下降，直至患者基本无症状。会话内痛苦评分也降低，这表明对与创伤相关的记忆产生了习惯化。本病例研究证明了特定的认知行为疗法干预如何能有效地应用于一种形式的转换障碍。
