背景:一些强迫症(OCD)患者由于暴露和反应预防治疗的厌恶性质而拒绝或退出治疗,当他们不得不面对和忍受不愉快的想法时,情感,和身体的感觉。的确,一项研究表明,体验不愉快想法的意愿更高,情感,和身体感觉(WTE)预测更好的治疗结果,但这一发现尚未被复制。
方法:我们在接受多模式治疗的324例强迫症住院患者样本中检查了入院时WTE是否预测了治疗结果,这些患者接受了包括认知行为治疗以及暴露和反应预防会话的多模式治疗。
结果:从入院到出院,强迫症症状(基于强迫症特异性自我报告问卷)随着中至大效应大小(所有ps<0.001)而减少,整体功能(基于治疗师评分)随着大效应大小(d=1.3,p<0.001)而增加。与之前的发现相比,然而,WTE不能预测治疗结果(所有ps>0.005)。当控制任何合并症时,WTE对治疗结果的影响仍然不显著,年龄,性别,逗留时间,和抗抑郁药物,并没有受到这些变量的调节。
结论:结果表明,从入院到出院,住院治疗开始时WTE较高并不促进强迫症状的改善。然而,他们还表明,在住院治疗开始时降低WTE不会对治疗结果产生不利影响,也就是说,即使表明他们不愿意面对与暴露和反应预防相关的负面经历的患者,仍然可以实现显著的症状减轻。
BACKGROUND: Some persons with obsessive-compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet.
METHODS: We examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions.
RESULTS: Obsessive-compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps < 0.001) and global functioning (based on therapist ratings) increased with a large effect size (d = 1.3, p < 0.001) from admission to discharge. In contrast to previous findings, however, WTE did not predict treatment outcome (all ps > 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables.
CONCLUSIONS: Results indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive-compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.