早年情感创伤对轻症抑郁患者团体认知行为治疗效果的影响
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科技部“十二五”国家科技支撑项目(2012BAI01B04);国家自然科学基金委员会重大研究计划“情感和记忆的神经环路基础”培育项目(91232719);国家临床重点专科-上海市精神卫生中心(卫生部医政司2011-873);上海市申康发展中心“适宜技术联合开发推广应用项目(SHDC12016205);上海市科委医学引导项目(124119a8602);上海交通大学“医工交叉研究基金”面上项目(YG2011MS37);上海市卫生局公共卫生海外留学人才项目(GWHW201202)


Influence of early emotional trauma on treatment effect of group cognitive behavior therapy in milddepression patients
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    摘要:

    目的探讨早年情感创伤经历在轻症抑郁患者接受团体认知行为治疗时对疗效的影响。方法纳入102 例轻症抑郁患者,在常规治疗基础上,按照统一的结构式团体认知行为治疗手册进行治疗,使用早年创伤问卷简表评估早年创伤情况,用汉密尔顿抑郁量表(HAMD-17) 得分作为主要疗效指标,分别在基线,治疗4 周、8 周、12 周,随访24 周、36 周、48 周进行评估。根据情感创伤中位数将情感创伤分为高情感创伤组和低情感创伤组,对两组患者的治疗效果进行比较。结果12 周治疗结束时,高情感创伤组和低情感创伤组的轻症抑郁患者抑郁症状均达到临床治愈标准,且治疗效果一直持续到随访48 周末。早年情感创伤组间效应不显著(F=1.36,P=0.247),交互效应显著(F=3.72,P <0.05)。简单效应分析显示,两组患者接受团体认知行为治疗后,抑郁均改善明显( 高情感创伤组:F=77.98,P <0.01;低情感创伤组:F=22.45,P <0.01)。两组患者改善速度差异无统计学意义(t=1.19,P=0.237),但是4 周末时,低情感创伤组患者抑郁得分下降更快,与高情感创伤组比较差异有统计学意义(t=-2.54,P=0.013)。结论无论情感创伤的程度如何,轻症抑郁患者接受团体认知行为治疗之后,抑郁症状显著改善且效果较持久。但在症状改善初期,高情感创伤组的改善速度较慢。

    Abstract:

    Objective To explore the influence of early emotional trauma on treatment effect of groupcognitive behavior therapy (GCBT) in mild depression patients. Methods Totals of 102 mild depression patients were recruited in this study. All patients received standardized GCBT. Early Trauma Inventory Self Report-Short Form (ETISR-SF) was used to investigate childhood maltreatment. Hamilton Depression Scale (HAMD-17) was used as primary outcome in baseline,at 4 weeks,8 weeks,12 weeks of treatment,as well as 24 weeks,36 weeks,48 weeks during follow up. Patients were divided into high emotional trauma group and lowemotional trauma group based on the median of emontional trauma. The treatment effects were compared between two groups. Results Patients in two groups all met clinical cure standard after 12 weeks’treatment and 48 weeks’follow up. Early emotional trauma showed significant interaction effect (F=3.72,P<0.05) and no significant group effect (F=1.36,P=0.247). Simple effect analysis showed that both groups improved significantly after treatment (high emotional trauma group:F=77.98,P<0.01;low emotional trauma group:F=22.45,P<0.01). Although the improvement speed between two groups showed no significant difference (t=1.19,P=0.237),depressive score oflow emotional trauma group decreased faster than that of high emontional trauma group significantly (t=-2.54,P=0.013). Conclusions Depression symptom would be significantly improved and lasting after GCBT in allmild depression patients regardless of the degree of emotional trauma. But at the beginning,patients with high emontional trauma improve slower.

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吴丹萍 苑成梅 王宇 孙霞 卢卫红 薛莉莉 叶尘宇 陈涵 宋蕊 曹岚 陈俊 吴志国 彭代辉 方贻儒.早年情感创伤对轻症抑郁患者团体认知行为治疗效果的影响[J].神经疾病与精神卫生,2017,17(2):
DOI :10.3969/j. issn.1009-6574.2017.02.007.

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  • 在线发布日期: 2017-07-07