认知行为疗法治疗强迫症病人1例

1病人的基本增况病人女．19岁，大学一年级学生。主诉对做过的事总想来想去，痛恨自己及周围的一切，不满意自己的过去、现在和将来。想不回忆但控制不住，自知产生了心理障碍。去医科大学精神内科及外科检查未见异常。心理咨询门诊专家让其多参加体育锻炼，少想多做．但病人称很难做到，也不愿多想，可控制不住。病人称从初中开始出现上述情况，那时还能控制，“现在越来越不行了，怎么也学不进去，经常失眠，想到过自杀。”病人说初中时经常发呆，幻想将来工作、生活、家庭、婚姻等，很怕将来找一个父亲那样的人做丈夫。患者父亲要求很严…     

以正念为基础的认知行为模式在强迫症患者中的护理分析

目的:探讨以正念为基础的认知行为模式在强迫症患者中的应用效果.方法:收集2018年5月至2020年6月期间于郑州市第九人民医院采用以正念为基础的认知行为模式护理的33例强迫症患者临床资料,将其纳入观察组;另收集同期于同一医院采用常规护理的33例强迫症患者临床资料,将其纳入对照组.采用强迫症症状分类量表(修订版)中文版(...     

舍曲林合并认知行为疗法治疗强迫症的对照分析

目的评价舍曲林合并认知行为疗法对强迫症的治疗效果。方法将符合CCMD-3诊断标准的64例强迫症随机分为治疗组(n=32)和对照组(n=32),治疗组给予舍曲林合并认知行为治疗,对照组只给予舍曲林治疗。应用临床疗效标准及耶鲁布朗强迫症状量表(Y-BOCS)定期评定疗效。疗程6个月。结果在治疗第1、2、4和6个月末,治疗组疗效优于对照组,尤其对强迫行为疗效更好,两组差异具有显著性(t=3.19,3.39,3.40和4.39,P0.01)。结论舍曲林合并认知行为疗法治疗强迫症优于单独用舍曲林治疗。     

内观行为疗法治疗强迫症一例报告

目的:探讨内观行为疗法对强迫症患者的治疗效果.方法:以1例强迫检查患者为对象,进行为期12周共计24次的内观行为治疗.采用症状自评量表(SCL-90)和耶鲁-布朗强迫症严重程度量表(Y-BOCS),对患者进行治疗前和治疗后测评.结果:治疗后患者的Y-BOCS得分从治疗前的34分降低到9分,患者花费在检查上的时间和遍数显著减少,主观痛苦程度明显减低.在症状自评量表(SCL-90)上的多项指标的得分也均有显著降低.结论:内观行为疗法能够有效治疗该强迫症个案,缓解其症状,降低其主观痛苦程度,恢复其社会生活功能.     

帕罗西汀合并认知行为疗法治疗强迫症的对照研究

目的评价帕罗西汀合并认知行为疗法对强迫症的治疗效果。方法将符合中国精神障碍分类与诊断标准第3版的57例强迫症患者随机分为治疗组和对照组,治疗组给予帕罗西汀合并认知行为治疗,对照组单用帕罗西汀治疗,应用临床疗效标准及耶鲁布朗强迫量表(Y—BOCS)定期评定;观察6个月。结果在治疗1、2、4个月和6个月时,治疗组疗效显著优于对照组,尤其对强迫行为疗效更好。结论帕罗西汀合并认知行为疗法联合治疗强迫症效果优于单用帕罗西汀治疗。     

强迫症患者的病情程度与源检测能力、认知融合、正念的关系

目的:探索强迫症患者病情严重程度与源检测能力、认知融合、正念之间的关系。方法:选取符合精神障碍诊断与统计手册第5版(DSM-5)强迫症诊断标准的患者(最近8周未接受药物治疗)35例,同时招募正常对照35例。使用源检测三键任务范式、耶鲁-布朗强迫症状维度量表(Y-BOCS)、认知融合问卷(中文版)(CFQ)及正念注意觉知量表(MAAS)进行测评。源检测能力指标用平均条件化源辨别测量(ACSIM)。结果:强迫症患者ACSIM、MAAS得分均低于正常对照组,CFQ得分高于正常对照组,(均P<0.001)。逐步回归分析显示,所有被试的ACSIM得分与Y-BOCS得分负向关联(β=-30.67,P<0.01),CFQ得分与Y-BOCS得分正向关联(β=0.54,P<0.01)。结论:强迫症患者的病情严重程度与源检测能力、认知融合关系紧密。     

正念体悟疗法干预9例强迫症效果报告

目的:探讨正念体悟疗法对强迫症的干预效果。方法:对9名满足入组标准的强迫症个案开展为期23周的正念体悟疗法干预,使用症状自评量表(SCL-90),耶鲁-布朗强迫程度严重量表(Y-BOCS)进行干预前和干预后测量,以检验其效果。结果:对数据进行t检验发现,来访者SCL-90除敌对因子分(t=1.915,P0.05)前后测没有达到统计学的显著差异之外,总均分(t=5.851,P0.01)和其他因子分(躯体化t=3.360,和强迫t=4.203,人际关系t=6.804,抑郁t=5.997,焦虑t=3.763,恐怖t=5.146,偏执t=6.424,精神病性t=4.661,其他t=4.482;P均0.05)均是后测显著低于前测,Y-BOCS分数(t=7.007,P0.05)后测也显著低于前测。结论:正念体悟疗法干预强迫症有效,能显著缓解来访者的强迫症症状,降低其主观痛苦程度,恢复其社会生活功能。     

认知行为疗法对精分症患者自卑心理治疗

精神分裂症与其它躯体疾病一样同属疾病范畴，但社会上对本病持有偏见。因此，患有精神分裂症患者常会随着病情好转、自知力恢复而出现心理问题。本文通过即将回归社会患者的心理调查，发现有心理问题的占76％．自卑感具有普遍性，有些患者并因此出现行为障碍。为了试验认知行为疗法对精神分裂症患者康复期自卑心理的治疗效果，我院筛选出40例进行对照研究。1对象和方法1．1研究对象：具备三个条件：依据CCHD诊断标准，明确诊断为精神分裂症患者［‘］；按中国精神疾病治愈标准达到临床缓解，自知力恢复并将要出院的患者；自卑心理突出者…     

强迫症患者神经认知功能研究

目的：探讨强迫症认知功能障碍的特点。方法：采用韦氏记忆量表（WMS）、数字划销测验（NCT）、威斯康星卡片分类测验（WCST）评估记忆、注意、执行功能。结果：强迫症WMS中的1-100、长时记忆、记图、再生、联想、触摸、理解、短时记忆和记忆商均显著性较正常组差。强迫症NCT中的净分、第一、第三、第四、第五阶段划对数和第一、四阶段失误率均显著性较正常组羞；强迫症WCST中的总正确数，总错误数，持续性错误、非持续错误均显著性较正常组差。结论：强迫症的长时记忆、短时记忆、记忆商数、注意及执行功能均显著性较正常人差，其瞬时记忆无明显损害。     

评价强迫症患者应用认知行为护理疗法的临床效果

目的：分析评价强迫症患者应用认知行为护理疗法的临床效果。方法随机将我院收治的100例患者分为对照组和观察组,并观察两组患者护理效果。结果干预前后Y-BOCS评分比较差异具有显著性(P<0.05),干预后比较观察组评分明显高于对照组,且两组相比差异具有显著性(P<0.05)。结论认知行为护理疗法在强迫症患者护理中应用效果显著,值得临床推广使用。     

单一认知行为治疗对强迫障碍患者的疗效

目的:验证操作手册指导下的认知行为治疗(CBT)对未服药强迫障碍患者的疗效和可接受性.方法:纳入符合美国精神障碍诊断和统计手册第4版(DSM-IV)强迫障碍诊断标准的门诊患者17例,在自行编制强迫障碍CBT操作手册指导下进行12周个别治疗.应用耶鲁-布朗强迫量表(Y-BOCS)、汉密顿抑郁量表(HAMD)和汉密顿焦虑量表(HAMA)分别于基线和12周治疗结束时进行临床症状评估.研究期间不服用任何精神药物.结果:17例强迫障碍患者中有14例完成了12次治疗(脱落率为17.6％).12周治疗结束时,Y-BOCS总分由(22.4±5.9)下降至(9.7±6.0)分,HAMD分由(9.2±4.2)下降至(4.6±3.7),HAMA分由(14.1±4.7)下降至(5.9±4.6),均P＜0.01.按照意向性治疗的统计方法,CBT对强迫障碍的有效率为70.6％ (12/17),缓解率为52.9％ (9/17).结论:手册指导下的单一认知行为治疗能显著改善强迫障碍患者的强迫症状、焦虑和抑郁情绪,且患者对该疗法的接受度较高,治疗依从性较好.     

Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder

BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.     

A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder

Objectives. Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent relapse in recurrent depression. More recently it has been applied to individuals at high risk of suicide or currently suffering with anxiety and depression. The aim of this study was to consider the feasibility of MBCT for individuals with a diagnosis of borderline personality disorder (BPD). Design. The design of the study was a repeated measures, quasi‐experimental design employing within‐subject and between‐subject comparisons of a sample of participants with BPD. Based on previous studies and theoretical models of the effect of mindfulness and of cognitive therapy, pre‐ and post‐group measures of mindfulness, depression, anxiety, dissociation, impulsivity, experiential avoidance, and attention were obtained. Method. Participants attended an 8‐week adapted MBCT (MBCT‐a) group intervention. A total of 22 participants were assessed pre‐ and post‐intervention and were subsequently divided for analysis into two groups: treatment completers (N= 16) and non‐completers (number of sessions attended < 4; N= 6). Results. The study found that MBCT‐a is acceptable to individuals with BPD. Using intention to treat analyses, only attentional control improved. However, post hoc analyses of treatment improvers (N= 9) identified changes in mindfulness and somatoform dissociation. A dose‐effect analysis suggested a weak improvement in mindfulness, experiential avoidance, state anxiety, and somatoform dissociation. Conclusions. This study suggests that further exploration of MBCT for use with individuals with BPD is merited. The study lends tentative support for attentional and avoidance models of the effects of mindfulness.     

Thought disorder in patients with obsessive-compulsive disorder

We examined the presence of disordered thinking/perception in patients with obsessive-compulsive disorder (OCD). Recently, an obsession model has been proposed, which classifies obsessions into two different subtypes: autogenous obsessions and reactive obsessions (Lee & Kwon, 2003). Based on this model, we hypothesized that OCD patients primarily displaying autogenous obsessions as opposed to reactive obsessions would display more severely disordered thinking/perception. We compared 15 OCD patients primarily displaying autogenous obsessions (AOs), 14 OCD patients primarily displaying reactive obsessions (ROs), 32 patients with schizophrenia (SPRs), and 28 patients with other anxiety disorders (OADs) with respect to thought disorders as assessed by the Comprehensive System of the Rorschach Inkblot Test. Results indicated that both AOs and SPRs displayed more severe thought disorders compared to ROs or OADs. Theoretical and clinical implications are discussed.     

Computerised cognitive behaviour therapy for obsessive-compulsive disorder: a systematic review

BACKGROUND: Computer-guided therapy is an innovative treatment strategy that could have an important role in the future of psychological treatment. This paper summarises the available published evidence that assesses the effectiveness of a computerised cognitive behaviour therapy (CCBT) for obsessive-compulsive disorder (OCD). METHODS: Fifteen electronic bibliographic databases including Medline, Embase, the Cochrane Library, Cinahl, PsycINFO, Biological Abstracts, HMIC and NHS CRD databases were comprehensively searched in March 2004: ['obsessive compulsive disorder' (text and indexed terms)] AND ['cognitive therapy' (text and indexed terms)] AND ['computer' (text and indexed terms)]. Reference lists of included studies, guidelines, generic research, trials registers and specialist mental health sites were hand-searched. RESULTS: The search produced 149 citations from which we identified two RCTs and two single-arm studies with relevant data. All four studies used one software programme - BTSteps.In the large RCT, YBOCS effect sizes for BTSteps, therapist-led cognitive behaviour therapy (TCBT) and relaxation (RLX) were 0.84, 1.22, and 0.35, respectively. The smaller RCT found significantly better outcomes with brief scheduled support compared to brief on-demand phone support. CONCLUSIONS: BTSteps was as good as TCBT for reducing time spent in rituals and obsessions and for improving the Work and Social Adjustment Scale (WSA), and was superior to RLX treatment. The available evidence also showed that improvement of OCD persisted beyond the end of CCBT. TCBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure. Such a system has the potential to widen the access to CBT in general and considerably shorten clinician-guided care.     

Parents of patients with obsessive-compulsive disorder

Family histories obtained from 27 patients with obsessive-compulsive disorder failed to find a single parent with the disorder. To augment the family history data the Leyton Obsessional Inventory was completed by a subset of 10 patients and by their 20 parents. Although as a group parents showed lower Leyton Obsessional Inventory symptom scores than their obsessional offspring, 3 parents who had not been identified by family history were distinguished by high symptom scores in the absence of significant resistance or interference.     

Frontal EEG asymmetry and symptom response to cognitive behavioral therapy in patients with social anxiety disorder

Although previous studies have shown that socially anxious individuals exhibit greater relative right frontal electroencephalogram (EEG) activity at rest, no studies have investigated whether improvements in symptoms as a result of treatment are associated with concomitant changes in resting brain activity. Regional EEG activity was measured at rest in 23 patients with social anxiety disorder (SAD) before and after cognitive behavioral therapy (CBT). Results indicated that patients shifted significantly from greater relative right to greater relative left resting frontal brain activity from pre- to posttreatment. Greater left frontal EEG activity at pretreatment predicted greater reduction in social anxiety from pre- to posttreatment and lower posttreatment social anxiety after accounting for pretreatment symptoms. These relations were specific to the frontal alpha EEG asymmetry metric. These preliminary findings suggest that resting frontal EEG asymmetry may be a predictor of symptom change and endstate functioning in SAD patients who undergo efficacious psychological treatment.     

Perceived criticism predicts severity of anxiety symptoms after behavioral treatment in patients with obsessive-compulsive disorder and panic disorder with agoraphobia

In prospective research, psychiatric patients' perceived criticism (PC) from family members has been linked to higher rates of relapse and worse treatment outcome. Researchers have disagreed about whether PC contributes to poor treatment outcomes or whether it merely reflects the severity of a patient's disturbance. In this study, structural equation modeling was used to conduct a cross-lagged panel analysis of the relationship between PC and anxiety symptom severity assessed before and after treatment in anxiety-disordered patients. PC was found to be unrelated to concurrent symptom severity. Furthermore, pretreatment PC significantly predicted posttreatment symptom severity over and above the effect of pretreatment symptom severity, whereas pretreatment symptom severity failed to significantly predict posttreatment PC. Thus, these results are consistent with (although not proof of) the hypothesis that PC detracts from patients' ability to respond to treatment, and inconsistent with the hypothesis that PC is a reflection of a patient's symptom severity.     

Comparative cognitive profiles of obsessive-compulsive disorder and schizophrenia

A body of neuropsychological research revealed cognitive impairments in patients suffering from obsessive-compulsive disorder (OCD). Only few investigations addressed the question of how specific these impairments are. The present study compared the performances of 19 subjects with OCD to 19 subjects with schizophrenia and 19 healthy controls on neuropsychological tasks across the main cognitive domains (memory, attention, visual spatial and executive functioning). For purposes of data-reduction, single test measures of the test battery applied were aggregated into eight cognitive domain scores. Contrary to our expectation we found comparable performance profiles of obsessive-compulsive (OC) and schizophrenia subjects across domains with impairments primarily affecting simple attentional skills and memory skills. However, deficits of subjects with schizophrenia were greater in magnitude than those of subjects with OCD on all domains assessed. Elevated depression scores exerted a relevant impact on performance deficits in the OC but not in the schizophrenia sample.