焦虑认同法与正念策略管理强迫思维的随机对照研究  

A random controlled study comparing anxiety ratification therapy and mindfulness-based strategy in managing obsessions

作　　者：胡思思[1] 汪孟允 熊玲[1] 张仲明[1] 

机构地区：[1]西南大学心理学部,重庆400715

出　　处：《中国心理卫生杂志》2016年第4期273-280,共8页Chinese Mental Health Journal

基　　金：国家自然科学基金项目(31171006);留学基金委(201306995011);西南大学心理学部2011项目(tr201205-5)

摘　　要：目的：检验使用焦虑认同法管理强迫思维的有效性。方法：选取第三军医大学附属医院强迫症患者60名,利用随机数字表法将患者分配到三组,分别接受焦虑认同法干预（n=20）、正念策略干预（n=20）和不作特殊干预的纯暴露（n=20）。实验包括基线、干预和恢复3个阶段。每阶段均使用循环磁带暴露范式,即患者通过耳机固定频率地听自己的强迫思维。在干预阶段,三组患者接受各自方法的指导语管理强迫思维。用视觉模拟评定量表（VAS）评估患者从基线到恢复阶段焦虑、中和愿望及痛苦程度的改善情况。结果：最终53人完成实验。纯暴露组（n=16）恢复阶段的焦虑与痛苦程度得分与基线差异无统计学意义（均P〉0.05）,中和愿望得分高于基线（P﹤0.05）;焦虑认同组（n=18）与正念组（n=19）恢复阶段的焦虑和中和愿望得分均低于基线（均P﹤0.05）;焦虑认同组恢复阶段的痛苦程度得分低于基线（P﹤0.05）,正念组差异无统计学意义（P〉0.05）。焦虑认同组效应值（d）为0.66~0.70,正念组d值为0.39~0.54。结论：焦虑认同法能够降低强迫症患者的焦虑水平、中和愿望水平和缓解痛苦程度,帮助强迫症患者有效管理强迫思维。Objective： To test the efficacy of anxiety ratification therapy during brief exposure to obsessions in obsessive-compulsive patients. Methods： Totally 60 patients w ith obsessive-compulsive disorder w ere recruited and randomized into 3 groups. Patients w ere asked to listen to their ow n obsession through headphones during three time phases,at baseline,during an intervention phase and during a return to baseline. During the intervention phase,they w ere instructed to deal w ith their obsessions using anxiety ratification instructions（ n = 20）,mindfulness instructions（ n = 20） or exposure instructions（ n = 20）. The improvement of anxiety,urge to neutralize and distress w ere assessed w ith the Visual Analogue Scale（ VAS）. Results： Fifty-three patients successfully completed the experiment. From the baseline to a return to baseline,anxiety and distress did not improve significantly（ Ps 0. 05）,w hile urge to neutralize significantly elevated（ P〈0. 05） in exposure group. Patients experienced a greater decline in anxiety and urge to neutralize in anxiety ratification group and mindfulness group（ Ps 0. 05） from the baseline to a return to baseline. From the baseline to a return to baseline,patients＇ distress declined significantly in anxiety ratification group（ n 0. 05）,w hereas the difference of mindfulness group w as not significant（ n 0. 05）. Anxiety ratification therapy had the effect size（ d） ranging betw een 0. 66 and 0. 70,and mindfulness had the effect size（ d） ranging betw een 0. 39 and 0. 54. Conclusion： The results provide the evidence that anxiety ratification therapy could significantly improve the anxiety,urge to neutralize and distress of patients w ith obsessive-compulsive disorder,and help them to effectively manage their obsessions.

关 键 词：强迫思维 焦虑认同法 正念策略 循环磁带暴露范式 

分 类 号：R749.79[医药卫生—神经病学与精神病学]