Longstreth G F, Mason C, Schreiber I G, Tsao-Wei D
Kaiser Permanente Health Care Program, San Diego, USA.
Int J Group Psychother. 1998 Oct;48(4):533-41. doi: 10.1080/00207284.1998.11491571.
Molested women who completed a series of 16 weekly group psychotherapy sessions conducted by social workers improved substantially regarding various aspects of psychological functioning, including self-image, coping techniques, relationship issues, and mothering. In addition, there was significant improvement in all psychological symptom scales and all global indices of symptomatic distress measured by the SCL-90-R. Furthermore, the improvement was present immediately after therapy and, with the exception of the hostility score, persisted 1 year later. Although the somatization score was reduced, the number of visits for physical symptoms did not change. The patients studied manifested characteristics typical of previously surveyed women with a history of childhood abuse, including a frequent history of major surgery (Drossman et al., 1996; Longstreth & Wolde-Tsadik, 1993; Springs & Friedrich, 1992) and, in some, a previous problem with alcohol (Springs & Friedrich, 1992; Walker et al., 1995) or drugs (Longstreth & Wolde-Tsadik, 1993; Miller & McCluskey-Fawcett, 1993; Springs & Friedrich, 1992). Also, nearly one half of the subjects had irritable bowel syndrome, the prototypical functional bowel disorder (Drossman et al., 1995; Longstreth & Wolde-Tsadik, 1993; Scarinci et al., 1994; Walker et al., 1995). Most of their baseline SCL-90-R scores were > 1 SD above the nonpatient norms. A problem inherent in assessing the long-term benefit of this study and other group psychotherapy studies is the tendency for some patients to continue similar or different forms of therapy after completing the group sessions. More than one half of patients received subsequent therapy that could have influenced their status at 1-year follow-up. However, most of the symptom dimensions and all global indices were similar 1 year posttherapy in the women who did not receive more treatment as compared to results in the women who did. Patients who received additional therapy had higher somatization scores before, immediately after, and 1 year posttherapy; scores in the other group increased 1 year posttherapy. Although the indications for subsequent therapy were not surveyed, there was an association between additional psychological care seeking and somatization. Furthermore, improvement in psychological status reflected by the phobic-anxiety score immediately posttherapy may have contributed to the decision of some patients to seek subsequent therapy. In the group without additional treatment, the loss of some of the initial somatization improvement at 1 year may have contributed to the lack of reduction in medical care visits in the combined groups. We speculate that provision of additional therapy to more patients might have had a long-term effect on somatization and reduced medical visits. We obtained complete psychological data and nearly complete medical-visit data on our patients, and our survey included 1-year follow-up. Our survey did not meet rigorous methodological standards for an outcome study, however. We surveyed only a small number of patients and did not collect similar data on an untreated control group. It was not possible to distinguish health care visits for organic versus functional disorders, but such a distinction may be artificial, because psychological factors may influence health care seeking for "organic" illness. Because our measurements came from a subset of our patients who were willing to complete the survey questionnaires, we do not know how generalizable the findings are. There is increasing awareness among health care professionals that childhood sexual abuse is common and that it may have serious and long-term psychological and medical sequelae. Our data suggest that group psychotherapy by social workers for women victims may have long-lasting psychological and somatic symptom benefits. Reduction in health care usage was not found, and this outcome may require the identification and treatment of patients who need additi
接受由社会工作者主持的为期16周的系列团体心理治疗的受虐妇女，在心理功能的各个方面都有显著改善，包括自我形象、应对技巧、人际关系问题和育儿能力。此外，在由症状自评量表-90修订版（SCL-90-R）测量的所有心理症状量表和所有症状困扰的整体指标上都有显著改善。此外，治疗后立即出现了改善，除了敌对得分外，一年后仍持续存在。虽然躯体化得分降低了，但身体症状的就诊次数没有变化。所研究的患者表现出先前调查的有童年虐待史女性的典型特征，包括频繁的大手术史（德罗斯曼等人，1996年；朗斯特雷思和沃尔德-萨迪克，1993年；斯普林斯和弗里德里希，1992年），并且在一些患者中，有先前的酒精（斯普林斯和弗里德里希，1992年；沃克等人，1995年）或药物（朗斯特雷思和沃尔德-萨迪克，1993年；米勒和麦克卢斯基-福西特，1993年；斯普林斯和弗里德里希，1992年）问题。此外，近一半的受试者患有肠易激综合征，这是典型的功能性肠病（德罗斯曼等人，1995年；朗斯特雷思和沃尔德-萨迪克，1993年；斯卡林奇等人，1994年；沃克等人，1995年）。她们大多数的SCL-90-R基线得分比非患者常模高出1个标准差以上。评估本研究及其他团体心理治疗研究的长期益处时存在的一个固有问题是，一些患者在完成团体治疗后倾向于继续接受类似或不同形式的治疗。超过一半的患者接受了后续治疗，这可能影响了她们在1年随访时的状况。然而，与接受更多治疗的女性相比，未接受更多治疗的女性在治疗后1年的大多数症状维度和所有整体指标相似。接受额外治疗的患者在治疗前、治疗后立即和治疗后1年的躯体化得分更高；另一组的得分在治疗后1年有所增加。虽然未调查后续治疗的指征，但寻求额外心理护理与躯体化之间存在关联。此外，治疗后立即出现的恐惧焦虑得分所反映的心理状态改善可能促使一些患者决定寻求后续治疗。在没有额外治疗的组中，1年后最初的一些躯体化改善的丧失可能导致了合并组中医疗就诊次数没有减少。我们推测，为更多患者提供额外治疗可能对躯体化有长期影响并减少医疗就诊次数。我们获得了患者完整的心理数据和几乎完整的医疗就诊数据，并且我们的调查包括了1年的随访。然而，我们的调查不符合结果研究的严格方法学标准。我们只调查了少数患者，并且没有收集未治疗对照组的类似数据。无法区分因器质性疾病与功能性疾病的医疗就诊，但这种区分可能是人为的，因为心理因素可能影响对“器质性”疾病的医疗寻求。由于我们的测量来自愿意完成调查问卷的患者子集，我们不知道这些发现的可推广性如何。医疗保健专业人员越来越意识到童年性虐待很常见，并且它可能有严重和长期的心理及医学后果。我们的数据表明，社会工作者为女性受害者提供的团体心理治疗可能对心理和躯体症状有持久益处。未发现医疗保健使用的减少，并且这一结果可能需要识别和治疗需要额外治疗的患者。
