Campbell-Sills Laura, Roy-Byrne Peter P, Craske Michelle G, Bystritsky Alexander, Sullivan Greer, Stein Murray B
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
Depress Anxiety. 2016 Dec;33(12):1099-1106. doi: 10.1002/da.22574. Epub 2016 Oct 24.
Many patients with anxiety disorders remain symptomatic after receiving evidence-based treatment, yet research on treatment-resistant anxiety is limited. We evaluated effects of cognitive behavioral therapy (CBT) on outcomes of patients with medication-resistant anxiety disorders using data from the Coordinated Anxiety Learning and Management (CALM) trial.
Primary care patients who met study entry criteria (including DSM-IV diagnosis of generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder) despite ongoing pharmacotherapy of appropriate type, dose, and duration were classified as medication resistant (n = 227). Logistic regression was used to estimate effects of CALM's CBT program (CALM-CBT; chosen by 104 of 117 medication-resistant patients randomized to CALM) versus usual care (UC; n = 110) on response [≥ 50% reduction of 12-item Brief Symptom Inventory (BSI-12) anxiety and somatic symptom score] and remission (BSI-12 < 6) at 6, 12, and 18 months. Within-group analyses examined outcomes by treatment choice (CBT vs. CBT plus medication management) and CBT dose.
Approximately 58% of medication-resistant CALM-CBT patients responded and 46% remitted during the study. Relative to UC, CALM-CBT was associated with greater response at 6 months (AOR = 3.78, 95% CI 2.02-7.07) and 12 months (AOR = 2.49, 95% CI 1.36-4.58) and remission at 6, 12, and 18 months (AORs = 2.44 to 3.18). Patients in CBT plus medication management fared no better than those in CBT only. Some evidence suggested higher CBT dose produced better outcomes.
CBT can improve outcomes for patients whose anxiety symptoms are resistant to standard pharmacotherapy.
许多焦虑症患者在接受循证治疗后仍有症状，但关于难治性焦虑症治疗的研究有限。我们使用来自焦虑症协同学习与管理（CALM）试验的数据，评估了认知行为疗法（CBT）对药物难治性焦虑症患者治疗结果的影响。
尽管接受了适当类型、剂量和疗程的药物治疗，但符合研究入选标准（包括根据《精神疾病诊断与统计手册》第四版诊断为广泛性焦虑症、惊恐障碍、创伤后应激障碍或社交焦虑症）的初级保健患者被归类为药物难治性患者（n = 227）。采用逻辑回归分析评估CALM的CBT项目（CALM-CBT；117名随机分配至CALM的药物难治性患者中有104名选择该项目）与常规治疗（UC；n = 110）对6个月、12个月和18个月时的反应[12项简明症状量表（BSI-12）焦虑和躯体症状评分降低≥50%]和缓解（BSI-12 < 6）的影响。组内分析按治疗选择（CBT与CBT加药物管理）和CBT剂量检查结果。
在研究期间，约58%的药物难治性CALM-CBT患者有反应，46%达到缓解。相对于UC，CALM-CBT在6个月（优势比[AOR]=3.78，95%置信区间[CI]2.02 - 7.07）和12个月（AOR = 2.49，95%CI 1.36 - 4.58）时反应更大，在6个月、12个月和18个月时缓解情况更好（AOR为2.44至3.18）。接受CBT加药物管理的患者并不比仅接受CBT的患者情况更好。一些证据表明，更高的CBT剂量产生更好的结果。
CBT可改善焦虑症状对标准药物治疗耐药的患者的治疗结果。
