University of British Columbia Hospital, Vancouver, BC V6T2A1, Canada.
Behav Res Ther. 2010 Apr;48(4):295-303. doi: 10.1016/j.brat.2009.11.010. Epub 2009 Nov 24.
This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.
本研究检验了 Rachman 的认知行为方法治疗不伴有明显外显强迫的强迫症。将认知行为治疗与候补名单对照，并与压力管理训练（SMT）进行积极和可信的比较。在随机分配的 73 名成年人中，有 67 名完成了治疗，有 58 名可进行为期一年的随访。与候补名单相比，积极治疗导致 YBOCS 评分、强迫症相关认知和抑郁显著降低，社会功能改善。总体而言，CBT 和 SMT 显示出症状的大幅和相似减少。CBT 和 SMT 完成者的 YBOCS 强迫症状的前后效应量分别为 d = 2.34 和 1.90。尽管 CBT 在治疗后立即在某些症状测量上显示出对 SMT 的微小优势，但这些差异在随访期间不再明显。与 SMT 相比，CBT 在大多数与强迫症相关的认知上的变化更大。认知变化在 12 个月的随访中保持稳定，但认知测量的差异逐渐消失。两种治疗方法的强大且持久的效果与强迫症难以治疗的长期信念相矛盾。
