简化认知行为治疗对广泛性焦虑患者抑郁症状影响的研究

摘要

目的 探讨简化认知行为治疗(SCBT)对广泛性焦虑障碍(GAD)患者抑郁症状的疗效.方法 将134例GAD患者随机分为SCBT组(39例,应用SCBT治疗)、联合治疗组(53例,应用SCBT联合药物治疗)和药物组(42例,单用药物治疗),共治疗8周,随访32周.于基线及治疗后第2、4、6、8、12、32周末进行自编调查表、患者健康问卷-抑郁症状群量表(PHQ-9)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估.结果 治疗后第8周末三组临床治愈率比较差异无统计学意义(P＞0.05),治疗后第12、32周末SCBT组临床治愈率高于联合治疗组和药物组(P＜0.05).基线时联合治疗组PHQ-9评分高于SCBT组(P＜0.05),治疗后第12周末SCBT组评分低于联合治疗组和药物组(P＜0.05).基线时联合治疗组HAMD-17评分高于SCBT组(P＜0.05),治疗后第12周末SCBT组评分低于药物组(P＜0.05).三组、总体样本在各研究时点上HAMA与HAMD评分减分率均呈正相关(P＜0.01).结论 SCBT和药物治疗及联合治疗三种干预方式均有助于改善GAD患者的抑郁症状,三者间疗效差异不显著,SCBT的远期预后效果优于联合治疗和药物治疗.%Objective To explore the effects of simplified cognitive behavioral therapy (SCBT) on depressive symptoms in patients with generalized anxiety disorder (GAD).Methods A total of 134 patients with GAD were randomly divided into SCBT group treated with SCBT(39 cases),combination therapy group treated with SCBT combined with medication(53 cases),and medication group treated only with medication(42 cases) for 8 weeks and followed-up for 32 weeks.They were assessed with self-designed questionnaire,Patient Health Questionnaire (PHQ-9),Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale(HAMA) at the baseline and the end of the 2nd,4th,6th,8th,12th and 32nd week after treatment.Results There were no significant differences in clinical cure rates among three groups at the end of the 8th week after treatment(P ＞ 0.05).At the end of the 12th,32nd week after treatment,the clinical cure rates in SCBT group were significantly higher than those in combination therapy group and medication group(P ＜ 0.05).At the baseline,the scores of PHQ-9 and HAMD-17 in combination therapy group were significantly higher than those in SCBT group(P ＜ 0.05).At the 12th weekend after treatment,the score of PHQ-9 in SCBT group was significantly lower than that in combination therapy group and medication group (P ＜ 0.05);and the score of HAMD-17 in SCBT group was significantly lower than that in medication group(P ＜0.05).At all study points,the reduction rates of HAMD score were positively correlated with reduction rates of HAMA score in three groups and overall samples (P ＜ 0.01).Conclusion Depressive symptoms in patients with generalized anxiety disorder can be improved through SCBT,medication therapy as well as combination therapy,which shows little differences in effects.The long-term curative effect of SCBT is better than other two therapies.