Marks I M, Lelliott P, Basoglu M, Noshirvani H, Monteiro W, Cohen D, Kasvikis Y
Institute of Psychiatry, Denmark Hill, London.
Br J Psychiatry. 1988 Apr;152:522-34. doi: 10.1192/bjp.152.4.522.
A randomised treatment design for 49 chronically obsessive-compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11-16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.
针对49名患有慢性强迫性仪式行为的患者设计了一种随机治疗方案，并进行了三项对照比较。1. 在7周的自我暴露指导期间，氯米帕明治疗在改善仪式行为和抑郁的某些指标方面比安慰剂药物显著更有效；但这种效果是短暂的，随着药物治疗和暴露持续15周后消失。2. 在氯米帕明治疗的11至16周期间，自我暴露指导在几乎所有仪式行为指标和一些社会适应指标上比反暴露指导产生了显著得多的患者改善效果。3. 在8周后，在自我暴露指导（3小时）基础上增加治疗师辅助暴露（1.3小时）产生了一个几乎不显著的短暂效果，其临床价值存疑，在暴露结束时（第23周）以及到第52周的随访评估期间这种效果消失了。我们得出结论，在测试的三个治疗因素中，自我暴露是最有效的；氯米帕明起到了有限的辅助作用，而治疗师辅助暴露的作用微不足道。
