Department of Neuroscience and Mental Health, University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil.
J Clin Pharm Ther. 2012 Jun;37(3):328-34. doi: 10.1111/j.1365-2710.2011.01299.x. Epub 2011 Sep 28.
Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial-based thought record (TBTR), which targets the restructuring of patients' core beliefs.
To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT).
A two-arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven-column dysfunctional thought record and the positive data log in SAD patients according to DSM-IV.
Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0·001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression - Improvement. In addition, a one-way ancova, taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0·01 at mid-treatment and P = 0·004 at post-treatment), and SADS (P = 0·03 at post-treatment).
This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders.
社交焦虑障碍（SAD）通常呈慢性病程，并与功能严重受损相关。虽然临床试验的结果明确证实认知行为疗法治疗该障碍的疗效，但多达 50%的 SAD 患者改善甚微或无改善。因此，需要新的方法来提高 SAD 的治疗效果。一种这样的方法是基于试验的思维记录（TBTR），它针对患者核心信念的重构。
确定接受 TBTR 的患者在治疗后报告的社交焦虑和一般精神困扰症状是否少于接受常规认知疗法（CCT）的患者。
一项双臂随机试验比较了 TBTR（n = 17）与一组 CCT 技术（n = 19），根据 DSM-IV，CCT 技术包括标准的七栏功能失调思维记录和 SAD 患者的阳性数据日志。
两组患者在治疗过程中许多结局测量指标的评分均显著下降（P < 0·001），包括 Liebowitz 社交焦虑量表、负面评价恐惧量表（FNE）、社交回避和苦恼量表（SADS）、贝克焦虑量表和临床总体印象-改善。此外，单因素协方差分析（ancova），将基线值作为协变量，表明 TBTR 在降低 FNE 评分方面明显优于 CCT（治疗中期 P = 0·01，治疗后 P = 0·004），SADS 评分也有显著差异（治疗后 P = 0·03）。
本研究提供了初步证据，表明 TBTR 在降低 SAD 症状方面至少与 CCT 同样有效，这表明需要进一步研究 TBTR 在 SAD 和其他精神障碍中的应用。
