Tenneij Nienke H, van Megen Harold J G M, Denys Damiaan A J P, Westenberg Herman G M
Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
J Clin Psychiatry. 2005 Sep;66(9):1169-75. doi: 10.4088/jcp.v66n0913.
In many patients with obsessive-compulsive disorder (OCD), residual symptoms persist despite a clinically meaningful response. The objective of this study was to examine whether addition of behavior therapy would augment treatment outcome in these patients.
Ninety-six patients with DSM-IV OCD who had responded to 3 months of drug treatment were randomly assigned to either receive addition of behavior therapy or continue on drug treatment alone for 6 months. Patients who continued on drug treatment alone eventually received addition of behavior therapy for 6 months. Data were gathered from October 1998 to June 2002.
OCD patients who received addition of behavior therapy showed a greater improvement in obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score change = -3.9 in the completers sample) than those who continued on drug treatment alone (Y-BOCS score change = +3.9 for completers). Significantly more patients who received addition of behavior therapy were in remission compared with those who continued on drug treatment alone (p < .0001 for completers). Patients who received behavior therapy after 6 months of drug treatment alone showed a nonsignificant decline in obsessive-compulsive symptoms (Y-BOCS score change = -2.7 for completers); however, the remission rate found in this group was comparable to the remission rate found in the group of patients receiving addition of behavior therapy directly after responding to drug treatment.
The results indicate that addition of behavior therapy is beneficial for patients who have responded to drug treatment. The data also suggest that the effect is greater when behavior therapy is added immediately after attainment of the drug response.
在许多强迫症（OCD）患者中，尽管有临床意义上的反应，但残留症状仍持续存在。本研究的目的是检验增加行为疗法是否会改善这些患者的治疗效果。
96名对3个月药物治疗有反应的DSM-IV强迫症患者被随机分配，要么接受增加行为疗法，要么继续仅接受药物治疗6个月。仅继续接受药物治疗的患者最终接受了6个月的行为疗法。数据收集时间为1998年10月至2002年6月。
接受增加行为疗法的强迫症患者在强迫症状方面的改善程度（完成者样本中耶鲁-布朗强迫量表[Y-BOCS]评分变化=-3.9）大于仅继续接受药物治疗的患者（完成者Y-BOCS评分变化=+3.9）。与仅继续接受药物治疗的患者相比，接受增加行为疗法的患者缓解的比例显著更高（完成者p<.0001）。仅接受6个月药物治疗后接受行为疗法的患者强迫症状有不显著的下降（完成者Y-BOCS评分变化=-2.7）；然而，该组的缓解率与药物治疗有反应后直接接受增加行为疗法的患者组的缓解率相当。
结果表明，增加行为疗法对药物治疗有反应的患者有益。数据还表明，在药物治疗有反应后立即增加行为疗法，效果更大。
