Smits Jasper A J, Hofmann Stefan G, Rosenfield David, DeBoer Lindsey B, Costa Paul T, Simon Naomi M, O'Cleirigh Conall, Meuret Alicia E, Marques Luana, Otto Michael W, Pollack Mark H
Institute for Mental Health Research, University of Texas.
J Consult Clin Psychol. 2013 Dec;81(6):1100-12. doi: 10.1037/a0034120. Epub 2013 Aug 12.
The aim of the current study was to identify individual characteristics that (a) predict symptom improvement with group cognitive behavioral therapy (CBT) for social anxiety disorder (SAD; i.e., prognostic variables) or (b) moderate the effects of d-cycloserine (DCS) versus placebo augmentation of CBT for SAD (i.e., prescriptive variables).
Adults with SAD (N = 169) provided Liebowitz Social Anxiety Scale scores in a trial evaluating DCS augmentation of group CBT. Rate of symptom improvement during therapy and posttreatment symptom severity were evaluated using multilevel modeling. As predictors of these 2 parameters, we selected the range of variables assessed at baseline (demographic characteristics, clinical characteristics, personality traits). Using step-wise analyses, we first identified prognostic and prescriptive variables within each of these domains and then entered these significant predictors simultaneously in 1 final model.
African American ethnicity and cohabitation status were associated with greater overall rates of improvement during therapy and lower posttreatment severity. Higher initial severity was associated with a greater improvement during therapy but also higher posttreatment severity (the greater improvement was not enough to overcome the initial higher severity). DCS augmentation was evident only among individuals low in conscientiousness and high in agreeableness.
African American ethnicity, cohabitation status, and initial severity are prognostic of favorable CBT outcomes in SAD. DCS augmentation appears particularly useful for patients low in conscientiousness and high in agreeableness. These findings can guide clinicians in making decisions about treatment strategies and can help direct research on the mechanisms of these treatments.
本研究旨在确定个体特征，这些特征：（a）预测社交焦虑障碍（SAD）患者接受团体认知行为疗法（CBT）后的症状改善情况（即预后变量）；或（b）调节d - 环丝氨酸（DCS）与安慰剂增强CBT治疗SAD效果之间的差异（即处方变量）。
在一项评估DCS增强团体CBT治疗效果的试验中，169名患有SAD的成年人提供了莱博维茨社交焦虑量表得分。使用多层次模型评估治疗期间的症状改善率和治疗后症状严重程度。作为这两个参数的预测因素，我们选择了在基线时评估的一系列变量（人口统计学特征、临床特征、人格特质）。通过逐步分析，我们首先在每个领域内确定预后和处方变量，然后将这些显著预测因素同时纳入一个最终模型。
非裔美国人种族和同居状况与治疗期间总体改善率较高以及治疗后严重程度较低相关。初始严重程度较高与治疗期间更大的改善相关，但治疗后严重程度也较高（更大的改善不足以克服初始较高的严重程度）。DCS增强仅在尽责性低且宜人性高得个体中明显。
非裔美国人种族、同居状况和初始严重程度是SAD患者CBT良好预后的预测因素。DCS增强对尽责性低且宜人性高的患者似乎特别有用。这些发现可以指导临床医生做出治疗策略决策，并有助于指导对这些治疗机制的研究。
