群组认知行为疗法与个体认知行为疗法治疗躯体化障碍患者的疗效比较：一项随机对照试验。

Effectiveness of group versus individual cognitive-behavioral therapy in patients with abridged somatization disorder: a randomized controlled trial.

机构信息

University of Balearic Islands, Palma de Mallorca, Baleares, Spain.

出版信息

Psychosom Med. 2013 Jul-Aug;75(6):600-8. doi: 10.1097/PSY.0b013e31829a8904. Epub 2013 Jun 20.

DOI:10.1097/PSY.0b013e31829a8904

PMID:23788694

Abstract

OBJECTIVE

To evaluate the effectiveness and feasibility of a cognitive-behavioral program for patients in primary care units who were diagnosed as having abridged somatization disorder.

METHOD

A multicenter, randomized controlled trial was designed. One hundred sixty-eight patients were recruited from 29 primary care units and randomly assigned to one of three arms: treatment as usual (TAU), individual cognitive-behavioral therapy (CBT), and group CBT. Somatic symptoms were measured using the Screening for Somatoform Disorders and the Severity of Somatic Symptoms scale. The Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale were used to assess the severity of anxiety and depression.

RESULTS

Individual CBT achieves greater changes in the Screening for Somatoform Disorders posttreatment compared with group CBT (mean [95% confidence interval], 14.17 [11.9-16.3] versus 11.63 [9.4-13.7], p < .001). These improvements were observed at 6 and 12 months (p < .001 and p < .001, respectively). For individual CBT versus TAU, the number-needed-to-treat was 8, whereas for group CBT versus TAU, the number-needed-to-treat was 9. Individual CBT treatment resulted in lower anxiety scores compared with group CBT and TAU (7.33 [5.4-9.2] versus 11.47 [9.4-13.9] versus 13.07 [10.9-15.2], p < .001) posttreatment. Individual CBT and group CBT were associated with sustained benefits at 12-month follow-up compared with TAU (8.6 [6.6-10.6] versus 9.28 [7.2-11.2] versus 16.2 [13.9-18.5], p < .001). Depressive symptoms were lower for individual CBT posttreatment than for TAU (6.96 [5.3-8.6] versus 10.87-12.7], p < .01).

CONCLUSIONS

CBT in individual and group settings results in significant improvements in somatic symptoms among patients with somatoform abridged disorder compared with TAU. Individual CBT results in greater posttreatment improvements at 6-month and 12-month follow-ups.

TRIAL REGISTRATION

current controlled trials identifier ISRCTN69944771.

摘要

目的

评估认知行为方案对初级保健单位中被诊断为简化躯体化障碍患者的有效性和可行性。

方法

设计了一项多中心、随机对照试验。从 29 个初级保健单位招募了 168 名患者，并将他们随机分配到三个组之一：常规治疗（TAU）、个体认知行为疗法（CBT）和小组 CBT。躯体症状使用躯体化障碍筛查和躯体症状严重程度量表进行测量。汉密尔顿焦虑量表和汉密尔顿抑郁量表用于评估焦虑和抑郁的严重程度。

结果

个体 CBT 在治疗后躯体化障碍筛查的变化大于小组 CBT（平均值[95%置信区间]，14.17[11.9-16.3]与 11.63[9.4-13.7]，p<.001）。这些改善在 6 个月和 12 个月时均观察到（p<.001 和 p<.001）。对于个体 CBT 与 TAU 相比，需要治疗的人数为 8，而对于小组 CBT 与 TAU 相比，需要治疗的人数为 9。个体 CBT 治疗后焦虑评分低于小组 CBT 和 TAU（7.33[5.4-9.2]与 11.47[9.4-13.9]与 13.07[10.9-15.2]，p<.001）。个体 CBT 和小组 CBT 在 12 个月随访时与 TAU 相比均具有持续的获益（8.6[6.6-10.6]与 9.28[7.2-11.2]与 16.2[13.9-18.5]，p<.001）。个体 CBT 治疗后抑郁症状低于 TAU（6.96[5.3-8.6]与 10.87-12.7]，p<.01）。