Siffert Veronica, Riahi Colette, Stanley Melinda A, Fletcher Terri L
Michael E. DeBakey VA Medical Center, Houston, Texas.
Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
J Cogn Psychother. 2019 Feb 1;33(1):71-81. doi: 10.1891/0889-8391.33.1.71.
Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence. Upon reengagement in treatment, the therapist provided ERP in 34 sessions over 14 months, with 15 sessions via video telehealth to home. The patient used the OCD Workbook as a resource throughout treatment. The patient developed a hierarchy of target obsessions and rituals with associated subjective units of distress; completed exposures, beginning with lower-level items; and wrote imaginal scripts. He also received zolpidem for insomnia and venlafaxine for anxiety and depression. His scores on the nine-item Patient Health Questionnaire and Yale Brown Obsessive-Compulsive Scale decreased significantly.
暴露与反应阻止疗法（ERP）是强迫症（OCD）的金标准治疗方法；然而，很少有研究评估ERP在退伍军人中的应用。本案例研究描述了一名退伍军人的ERP及药物治疗情况，该退伍军人经历了暴力性性想法，并通过专注于痛苦想法以确保产生负面情绪或将想法转变为非暴力想法或形象的强迫行为来应对。该退伍军人此前曾接受过针对抑郁、焦虑和睡眠困难的支持性心理治疗及药物治疗，但治疗依从性较差。在重新接受治疗时，治疗师在14个月内进行了34次ERP治疗，其中15次通过视频远程医疗在家中进行。患者在整个治疗过程中使用《强迫症工作手册》作为参考资料。患者制定了目标强迫观念和仪式的等级制度以及相关的主观痛苦单位；从较低级别的项目开始完成暴露练习，并撰写想象脚本。他还因失眠服用了唑吡坦，因焦虑和抑郁服用了文拉法辛。他在九项患者健康问卷和耶鲁布朗强迫症量表上的得分显著下降。
