Storch Eric A, Björgvinsson Thröstur, Riemann Bradley, Lewin Adam B, Morales Miguel J, Murphy Tanya K
Department of Pediatrics, University of South Florida College of Medicine, St. Petersburg, FL 33701, USA.
Bull Menninger Clin. 2010 Spring;74(2):167-85. doi: 10.1521/bumc.2010.74.2.167.
Cognitive-behavioral therapy (CBT) with exposure and response prevention has proved to be an effective intervention for youth with obsessive-compulsive disorder (OCD). Given advantages over psychiatric medications (i.e., serotonin reuptake inhibitors) based on superior safety, maintenance of response, and efficacy, CBT is considered the first-line treatment for youth with OCD. Nevertheless, a number of clinical factors can complicate CBT for OCD course and outcome. The authors review factors associated with poor treatment response, highlighting variables that pertain to the child, the family environment, and the treatment process. Specific topics include diminished insight, family accommodation, comorbidity, symptom presentation, and cognitive deficits. Remarkably, CBT for OCD is robust to these encumbrances in the majority of cases, despite the need for protocol modifications to tailor treatment to the individual child.
暴露与反应阻止法的认知行为疗法（CBT）已被证明是治疗患有强迫症（OCD）青少年的有效干预措施。鉴于其相对于精神科药物（即血清素再摄取抑制剂）具有安全性更高、疗效维持性更好以及有效性更强的优势，CBT被视为患有强迫症青少年的一线治疗方法。然而，一些临床因素会使强迫症的CBT治疗过程和结果变得复杂。作者回顾了与治疗反应不佳相关的因素，重点强调了与儿童、家庭环境和治疗过程相关的变量。具体主题包括洞察力下降、家庭迁就、共病、症状表现和认知缺陷。值得注意的是，尽管需要对治疗方案进行调整以针对每个儿童量身定制治疗，但在大多数情况下，强迫症的CBT对这些障碍具有较强的耐受性。
