强迫症认知疗法中的改变机制：适应不良信念和图式的作用。
Mechanisms of change in cognitive therapy for obsessive compulsive disorder: role of maladaptive beliefs and schemas.
作者信息
Wilhelm Sabine, Berman Noah C, Keshaviah Aparna, Schwartz Rachel A, Steketee Gail
机构信息
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.
出版信息
Behav Res Ther. 2015 Feb;65:5-10. doi: 10.1016/j.brat.2014.12.006. Epub 2014 Dec 16.
Abstract
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.
摘要
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。
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本文引用的文献
1
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Int J Psychiatry Clin Pract. 2008;12(4):268-79. doi: 10.1080/13651500802095004.
2
Behavioral versus cognitive treatment of obsessive-compulsive disorder: an examination of outcome and mediators of change.行为治疗与认知治疗强迫症的比较：对治疗结果和变化中介因素的考察。
J Consult Clin Psychol. 2013 Jun;81(3):415-28. doi: 10.1037/a0031865. Epub 2013 Feb 18.
3
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Behav Res Ther. 2011 Nov;49(11):781-8. doi: 10.1016/j.brat.2011.08.007. Epub 2011 Sep 9.
4
Mechanisms of symptom reduction in treatment for obsessions.治疗强迫症中症状减轻的机制。
J Consult Clin Psychol. 2011 Oct;79(5):653-64. doi: 10.1037/a0024827.
5
Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder.模块认知疗法治疗强迫症的疗效预测因素。
Depress Anxiety. 2011 Apr;28(4):333-41. doi: 10.1002/da.20785. Epub 2011 Feb 9.
6
Modular Cognitive Therapy for Obsessive-Compulsive Disorder: A Wait-List Controlled Trial.强迫症的模块化认知疗法：一项等待列表对照试验。
J Cogn Psychother. 2009;23(4):294-305. doi: 10.1891/0889-8391.23.4.294.
7
Automatic associations and panic disorder: trajectories of change over the course of treatment.自动联想与惊恐障碍：治疗过程中的变化轨迹。
J Consult Clin Psychol. 2008 Dec;76(6):988-1002. doi: 10.1037/a0013113.
8
Preliminary evidence for cognitive mediation during cognitive-behavioral therapy of panic disorder.惊恐障碍认知行为疗法中认知调节的初步证据。
J Consult Clin Psychol. 2007 Jun;75(3):374-9. doi: 10.1037/0022-006X.75.3.374.
9
Temporal relationship between dysfunctional beliefs, self-efficacy and panic apprehension in the treatment of panic disorder with agoraphobia.伴有广场恐惧症的惊恐障碍治疗中功能失调信念、自我效能感与惊恐担忧之间的时间关系。
J Behav Ther Exp Psychiatry. 2007 Sep;38(3):275-92. doi: 10.1016/j.jbtep.2006.08.002. Epub 2006 Dec 8.
10
Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory--Part 2: Factor analyses and testing of a brief version.强迫信念问卷及闯入观念量表的心理测量学验证——第2部分：因素分析及简版测试
Behav Res Ther. 2005 Nov;43(11):1527-42. doi: 10.1016/j.brat.2004.07.010.
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