Wilhelm Sabine, Berman Noah C, Keshaviah Aparna, Schwartz Rachel A, Steketee Gail
Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States.
Massachusetts General Hospital, Harvard Medical School, Department of Psychiatry, 185 Cambridge Street, Suite 2000, Boston, MA 0214, United States.
Behav Res Ther. 2015 Feb;65:5-10. doi: 10.1016/j.brat.2014.12.006. Epub 2014 Dec 16.
The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.
本研究旨在确定接受认知疗法（CT）的中度重度强迫症（OCD）患者的改变机制。36名患有强迫症的成年人在24周内接受了认知疗法。在第0、4/6、12、16/18和24周时，独立评估人员评估了强迫症的严重程度，以及强迫观念和适应不良图式。为了检验改变机制，我们使用了具有随机截距和斜率的时变滞后回归模型。结果表明，完美主义、确定性强迫观念以及与依赖和无能相关的适应不良图式显著介导（改善）了治疗反应。总之，强迫症患者在行为症状减轻之前，完美主义/确定性信念以及与依赖/无能相关的适应不良图式会发生认知改变。在未来的强迫症治疗试验中针对这些机制将突出最相关的过程，并促进最大程度的改善。
