Thiel Nicola, Jacob Gitta A, Tuschen-Caffier Brunna, Herbst Nirmal, Külz Anne Katrin, Hertenstein Elisabeth, Nissen Christoph, Voderholzer Ulrich
Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany.
Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106 Freiburg, Germany; GAIA AG, Hamburg, Germany.
J Behav Ther Exp Psychiatry. 2016 Sep;52:59-67. doi: 10.1016/j.jbtep.2016.03.006. Epub 2016 Mar 12.
In spite of the availability of effective treatments for obsessive-compulsive disorder (OCD), many patients do not respond sufficiently or relapse. Treatments using other potentially effective methods such as experiential techniques need to be investigated. We developed a 12-week inpatient treatment augmenting exposure and response prevention (ERP) with schema therapy (ST) called STERP. The feasibility and effectiveness of STERP was tested..
In a pilot study, 10 inpatients with OCD who failed to respond to Cognitive Behavioral Therapy (CBT) with ERP received STERP. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) served as primary outcome. Secondary outcome measures were the Obsessive Compulsive Inventory-revised (OCI-R) and the Beck Depression Inventory (BDI-II). Treatment effects were assessed with t-tests for paired samples.
Significant reductions of the Y-BOCS, OCI-R and the BDI-II were found, with very large effect sizes (Cohen's d = 1.48-2.25). Results remained stable at 6 months follow-up. Five prior non-responders responded according to the 35% Y-BOCS symptom reduction criterion..
Lack of control group, small sample size and lack of repeated outcome measures during baseline.
STERP may be a feasible and potentially effective treatment for prior non-responders among OCD patients and thus worth further investigation in randomized controlled trials..
尽管有针对强迫症（OCD）的有效治疗方法，但许多患者反应不充分或复发。需要研究使用其他潜在有效方法（如体验技术）的治疗。我们开发了一种为期12周的住院治疗方案，即通过图式疗法（ST）增强暴露与反应阻止疗法（ERP），称为STERP。对STERP的可行性和有效性进行了测试。
在一项试点研究中，10名对采用ERP的认知行为疗法（CBT）无反应的强迫症住院患者接受了STERP治疗。耶鲁-布朗强迫症量表（Y-BOCS）作为主要结局指标。次要结局指标为修订版强迫观念与强迫行为量表（OCI-R）和贝克抑郁量表（BDI-II）。采用配对样本t检验评估治疗效果。
Y-BOCS、OCI-R和BDI-II均显著降低，效应量非常大（科恩d值=1.48 - 2.25）。在6个月的随访中结果保持稳定。5名之前无反应者根据Y-BOCS症状减轻35%的标准出现了反应。
缺乏对照组、样本量小以及在基线期间缺乏重复的结局测量。
STERP对于强迫症患者中之前无反应者可能是一种可行且潜在有效的治疗方法，因此值得在随机对照试验中进一步研究。
