成人注意缺陷多动障碍的团体辩证行为治疗  

Dialectical Behavior Therapy Group Skills Training for Adults with Attention-deficit/hyperactivity Disorder

作　　者：潘美蓉 邱孙伟 刘璐[1,2] 李海梅[1,2] 王玉凤[1,2] 钱秋谨 PAN Mei-rong;QIU Sun-wei;LIU Lu;LI Hai-mei;WANG Yu-feng;QIAN Qiu-jin(Peking University Sixth Hospital/Institute of Mental Health,Beijing 100191,China;NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100191,China)

机构地区：[1]北京大学第六医院,北京大学精神卫生研究所,北京100191 [2]国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191

出　　处：《中国临床心理学杂志》2024年第4期928-934,共7页Chinese Journal of Clinical Psychology

基　　金：北大六院主治医师骨干项目(BDLYYLZL2023-03);首都卫生发展科研专项(项目编号:首发2024-2-4114)。

摘　　要：目的:探讨辩证行为治疗(DBT)在国内成人注意缺陷多动障碍(ADHD)中的可行性和初步疗效,并分析疗效预测因素。方法:对20名成人ADHD开展团体DBT,收集参与度及满意度,分析治疗过程中、治疗结束时和结束3个月后随访时的多方面指标变化,并探索疗效预测因素。结果:治疗参与率为88.3%,满意度4.3~4.8分(满分5分);通过治疗患者核心症状(g=0.634~1.031)及抑郁情绪(g=0.379~0.664)显著下降,情绪调节(g=0.296~0.616)、觉察能力(g=-0.386~-0.581)及自尊水平(g=-0.305~-0.298)显著提升,并在3个月随访时维持。疗效积极预测因素包括男性、治疗早期起效及基线核心症状得分更高;消极预测因素包括基线执行功能更差及存在共患病。结论:DBT适用于我国成人ADHD,带来多方面改善。疗效预测因素分析为适应证优化提供了理论依据。Objective:The study aimed to explore the feasibility,acceptability,and preliminary efficacy of dialectical behavior therapy(DBT)in the Chinese population using a single-arm design,and to explore the potential predictors of the treatment outcome.Methods:Twenty adults with ADHD were allocated to the DBT group skills training and reported their feasibility and acceptability.Multiple liner models were used to estimate the preliminary efficacy of DBT since the ADHD core symptoms,emotional symptoms,emotional regulation strategies,executive functions(EF),and self-esteem were evaluated before treatment,mid-treatment,at the end of the 12-week DBT,and the 3-month follow-up.Multiple linear regressions were used to identify baseline predictors of the treatment outcome at the end of the 12-week DBT,and the 3-month follow-up.Results:Patients presented a high attendance rate(88.3%),and sufficient participant satisfaction(4.3~4.8/5scores).ADHD patients exhibited significant decreases in core symptoms(g=0.634~1.031)and depressive symptoms(g=0.379~0.664).Significant increases in emotional regulation strategies(g=0.296~0.616),self-awareness(g=-0.386~-0.581),and self-esteem(g=-0.305~-0.298)were also found,which could be maintained to T5.Gender(male),early onset of treatment,and higher scores of ADHD core symptoms at baseline predicted better treatment outcomes.Higher EF scores,the existence of psychiatric comorbidities and personality disorders and comorbidity at baseline predicted poorer treatment outcomes.Conclusion:The feasibility,acceptability,and preliminary efficacy of the Chinese version of DBT were demonstrated,suggesting that DBT would help patients to get reductions in multiple dimensions.The analysis of predictive factors of treatment outcomes provided a preliminary theoretical basis for the optimization of indications.

关 键 词：成人注意缺陷多动障碍 辩证行为疗法 可行性研究 预测因素 

分 类 号：R395.5[哲学宗教—心理学]