Didonna Fabrizio, Lanfredi Mariangela, Xodo Erica, Ferrari Clarissa, Rossi Roberta, Pedrini Laura
J Psychiatr Pract. 2019 Mar;25(2):156-170. doi: 10.1097/PRA.0000000000000377.
Cognitive-behavioral therapy (CBT) is the first-choice intervention for obsessive-compulsive disorder (OCD); however, a notable proportion of patients either do not respond to treatment or relapse after CBT. Mindfulness-based treatment has been suggested as an alternative or complementary therapeutic strategy for OCD. However, only a few studies have focused on its application in clinical samples.
To evaluate the impact of a new treatment, called "Mindfulness-based Cognitive Therapy for OCD." It is an 11-session manualized group intervention that integrates elements of CBT, mindfulness, compassion-focused therapy, and acceptance and commitment therapy.
The program was delivered to 35 patients with a primary diagnosis of OCD.
Participants demonstrated good adherence to the intervention. There was a significant reduction in mean total score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-TS) (P<0.001; Cohen d=-0.72). One third of the participants (n=13) showed at least a 25% reduction on the Y-BOCS-TS, and 40% of the sample (n=14) were assigned to a lower Y-BOCS severity category after treatment. Significant changes were also found in depression (P<0.001; d=-0.80), worry (P<0.001; d=-0.79), alexithymia (P<0.01; d=-0.41), dissociation (P<0.05; d=-0.46), and general psychopathology (P<0.001; d=-0.58). Repeated measures linear mixed models showed that OCD symptom reduction was associated with an increase in mindfulness skills, in particular on the acting with awareness (P=0.006), nonjudging (P=0.001), and nonreactivity (P=0.001) facets.
Overall, these findings are promising and they suggest that randomized controlled studies be conducted to test the effectiveness of this new treatment program for this challenging and disabling mental disorder.
认知行为疗法（CBT）是强迫症（OCD）的首选干预方法；然而，相当一部分患者对治疗无反应或在接受CBT后复发。基于正念的治疗已被建议作为强迫症的替代或补充治疗策略。然而，只有少数研究关注其在临床样本中的应用。
评估一种名为“基于正念的强迫症认知疗法”的新治疗方法的效果。这是一种为期11节的手册化团体干预，整合了CBT、正念、以慈悲为中心的疗法以及接纳与承诺疗法的元素。
该项目针对35名初步诊断为强迫症的患者实施。
参与者对干预表现出良好的依从性。耶鲁-布朗强迫症量表（Y-BOCS-TS）的平均总分显著降低（P<0.001；Cohen d=-0.72）。三分之一的参与者（n=13）在Y-BOCS-TS上至少降低了25%，40%的样本（n=14）在治疗后被归为Y-BOCS严重程度较低的类别。在抑郁（P<0.001；d=-0.80）、焦虑（P<0.001；d=-0.79）、述情障碍（P<0.01；d=-0.41）、分离（P<0.05；d=-0.46）和一般精神病理学（P<0.001；d=-0.58）方面也发现了显著变化。重复测量线性混合模型显示，强迫症症状的减轻与正念技能的提高有关，特别是在有意识行动（P=0.006）、不评判（P=0.001）和不反应（P=0.001）方面。
总体而言，这些发现很有前景，表明应进行随机对照研究以测试这种新治疗方案对这种具有挑战性和致残性精神障碍的有效性。
