目的:测试对常规认知行为疗法(CBT)无反应的强迫症(OCD)患者的多方面治疗方案。治疗解决了可能在维持强迫症中起作用的几个因素。
方法:我们设计了一种6天强化治疗,具有反应预防(ERP)格式的体内个体暴露,在患者家中接受24个治疗师辅助治疗小时和12个自我控制的ERP小时,包括行为激活和家庭干预。接下来,我们调查了效果(强迫症状,合并症,功能,生活质量,强迫症相关的互动模式)和可行性(辍学,治疗满意度,和组织)使用预测试后测试,后续测试前,和患者的定性数据,家庭成员,和治疗师。
结果:在22名参与者的样本中,强迫症状(Y-BOCSpre:28.7,post:15.9;WilcoxonS-R检验P<0.01)明显改善,大多数其他影响措施也是如此。结果主要是,但不完全是,保存在3个月的随访。只有1个辍学。患者,家庭成员,治疗师对治疗感到满意。治疗的实施没有造成困难。
结论:在强迫症无反应者中,一个多方面的,brief,密集的基于家庭的ERP计划目标因素保持OCD是有希望和可行的。需要额外的护理来保持改善。
OBJECTIVE: To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD.
METHODS: We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient\'s home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists.
RESULTS: In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties.
CONCLUSIONS: In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.