Speckens A E, van Hemert A M, Spinhoven P, Hawton K E, Bolk J H, Rooijmans H G
Department of Psychiatry, University Hospital, Leiden, Netherlands.
BMJ. 1995 Nov 18;311(7016):1328-32. doi: 10.1136/bmj.311.7016.1328.
To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care.
Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation.
General medical outpatient clinic in a university hospital.
An intervention group of 39 patients and a control group of 40 patients.
The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care.
The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner.
At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference -1.2; -2.0 to -0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference -2.5; -4.6 to -0.5). At 12 months of follow up the differences between the groups were largely maintained.
Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms.
与优化的医疗护理相比，研究认知行为疗法对患有医学上无法解释的身体症状患者的额外效果。
随机对照试验，在基线评估后6个月和12个月进行随访评估。
大学医院的普通内科门诊。
干预组39例患者和对照组40例患者。
干预组接受6至16次认知行为疗法治疗。使用的治疗技术包括识别和修正功能失调的自动思维以及旨在打破症状及其后果恶性循环的行为实验。对照组接受优化的医疗护理。
出现症状的变化程度、频率和强度、心理困扰、功能损害、疑病信念和态度，以及（随访12个月时）全科医生就诊次数。
随访6个月时，干预组报告的康复率更高（优势比0.40；95%置信区间0.16至1.00），身体症状的平均强度更低（差值-1.2；-2.0至-0.3），睡眠障碍更少（优势比0.38；0.15至0.94）。在对同时出现的基线差异进行调整后，干预组和对照组在症状频率（0.32；0.13至0.77）、社交（0.35；0.14至0.85）和休闲（0.36；0.14至0.93）活动受限以及疾病行为（差值-2.5；-4.6至-0.5）方面也存在差异。随访12个月时，两组之间的差异基本保持。
认知行为疗法似乎是治疗患有无法解释身体症状的普通内科患者的一种可行且有效的方法。
