Ball Samuel A, Maccarelli Lisa M, LaPaglia Donna M, Ostrowski Mark J
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
J Nerv Ment Dis. 2011 May;199(5):319-28. doi: 10.1097/NMD.0b013e3182174e6f.
We conducted a randomized comparison of dual-focus schema therapy with individual drug counseling as enhancements to the residential treatment of 105 substance-dependent patients with specific personality disorders versus those without. Both therapies were manual-guided and delivered for 6 months by experienced psychotherapists intensively trained and supervised with independent fidelity assessment. Using the Cox proportional hazards model, we found no psychotherapy differences in retention (days in treatment). Hierarchical linear modeling indicated that participants with personality disorders started with higher psychiatric, interpersonal, and dysphoria symptoms and that both therapies reduced symptoms in 6 months. Contrary to predictions, individual drug counseling resulted in more sustained reductions than did dual-focus schema therapy in several symptoms for several personality disorders. Our findings raised important questions about the added value of integrative or dual-focus therapies for co-occurring personality disorders and substance dependence relative to empirically supported therapies focused more specifically on addiction symptoms.
我们对双焦点图式疗法与个体药物咨询进行了随机比较，将其作为对105名患有特定人格障碍的物质依赖患者与未患人格障碍的患者进行住院治疗的强化措施。两种疗法均采用手册指导，由经验丰富的心理治疗师实施，这些治疗师经过强化培训和监督，并进行独立的保真度评估，为期6个月。使用Cox比例风险模型，我们发现两种心理治疗在治疗保留率（治疗天数）上没有差异。分层线性模型表明，患有人格障碍的参与者最初的精神症状、人际症状和烦躁症状更为严重，且两种疗法在6个月内均减轻了症状。与预测相反，在几种人格障碍的几种症状方面，个体药物咨询比双焦点图式疗法带来的症状持续减轻效果更明显。我们的研究结果提出了一些重要问题，即相对于更具体地针对成瘾症状的经验证支持疗法，综合或双焦点疗法对共病的人格障碍和物质依赖的附加价值如何。
