团体认知行为治疗对强迫症患者认知功能的影响

摘要

目的 探讨团体认知行为治疗对强迫症患者症状缓解和认知功能改善的效果.方法 纳入符合DSM-Ⅳ-TR诊断标准的强迫症患者48例,按1:1的比率分人药物治疗联合团体认知行为治疗组(联合治疗组,n＝24)和药物治疗组(n＝24).联合治疗组进行8周药物治疗及8次团体认知行为治疗,药物治疗组患者进行8周药物治疗.采用Y-BOCS评估治疗前后强迫症状,采用神经心理测试(包括连线测验、数字符号测验、数字广度测验、语义流畅性测验)评估治疗前后的认知功能.结果 治疗前联合治疗组与药物治疗组Y-BOCS总分及神经心理测试结果差异均无统计学意义.治疗后联合治疗组Y-BOCS评分[(18.7±3.1)分与(20.7±1.8)分]显著低于药物治疗组(t＝-2.75,P＜0.05);联合治疗组在连线测验中的B时间,数字符号测验,数字广度测验中的顺背、倒背以及语义流畅性测验中的正确数与药物治疗组比较差异均有统计学意义(t＝-2.93,3.47,2.06,2.54,7.22,均P＜0.05或P＜0.01).结论 团体认知行为治疗能有效缓解强迫症患者的症状严重程度,改善强迫症患者的认知功能.%Objective To explore the effect of group cognitive behavior therapy (GCBT) on symptom relief and cognitive function improvement of patients with obsessive-compulsive disorder (OCD).Methods Fourty-eight OCD patients who met the DSM-IV-TR diagnostic criteria were introduced into this study,and they were divided into GCBT combination therapy group (n＝24) and drug therapy group (n＝24).The GCBT combination therapy group was treated with 8 times of cognitive behavior therapy on the basis of drug therapy,and the drug therapy group was treated only with drug therapy.The Y-BOCS was used to evaluate the symptoms of obsessive-compulsive before and after the therapy.Neuropsychological tests (including Trail Making Test (TMT),Digit-Symbol Test (DST),Digit Span Test (DST),Category Fluency Test (CFT)) were used to evaluate the cognitive function before and after the treatment.Results Before the treatment,there was no significant difference between GCBT combination therapy group and drug therapy group on Y-BOCS and neuropsychological test results.After the treatment,the Y-BOCS score of GCBT combination therapy group was significantly lower than that of the drug therapy group (18.7:t:3.1 vs.20.7:t:1.8;t＝-2.75,P＜0.05).Meanwhile,there were significant differences between the GCBT combination therapy group and drug therapy group in the TMT (B time),Digit-Symbol Test,DST (Forward Digit Span),DST (Backward Digit Span),CFF(the correct number;t＝-2.93,3.47,2.06,2.54,7.22;P＜0.05 or P＜0.01).Conclusion GCBT show significant effect on relieving the severity of obsessive compulsive symptoms and improving the cognitive function of OCD patients.