团体归因训练对抑郁症、焦虑症、强迫症患者的心身作用及神经生物学机制
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摘要
第一部分抑郁症、焦虑症、强迫症的症状、生理-心理-社会功能比较
目的
比较抑郁症(major depressive disorder,MDD)、焦虑症(anxietydisorder,AD)和强迫症(obsessive-compulsive disorder,OCD)患者在症状、生理-心理-社会功能方面的差别。
方法
采用MDD组、AD组、OCD组比较的横断面研究设计,对45名MDD患者、45名AD患者和39名OCD患者进行了症状、生理-心理-社会功能的比较。生物学指标的检测包括血浆5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、皮质醇和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)浓度。心理社会功能评估通过以下量表完成:24项汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamiltonanxiety scale,HAMA)、抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-rating anxiety scale,SAS)、归因方式问卷(Attributional style questionnaire,ASQ)、Connor-Davidson韧性量表(Connor-Davidson resilience scale,CD-RISC)、自尊量表(Theself-esteem scale,SES)、主观幸福感指数量表(Index of well-being,IWB)、艾森克人格问卷简式量表中国版(Eysenck personalityquestionnaire short scale for Chinese,EPQ-RSC)、社会功能缺陷筛选量表(Social disability screening schedule,SDSS)。
结果
1.MDD组的HAMD、SDS、SAS总分均显著大于AD组和OCD组,MDD组和AD组的HAMA总分显著大于OCD组,OCD组的HAMD第21项强迫得分显著大于MDD组和AD组。
2.对于HAMD分量表症状,MDD组的迟缓、睡眠障碍、绝望因子得分显著高于AD组和OCD组,MDD组和AD组的焦虑/躯体化因子得分显著高于OCD组,MDD组和OCD组认知障碍因子得分显著大于AD组,OCD组的绝望因子得分显著大于AD组,体重和日夜变化因子三组间差异未达到统计学显著意义。
3.本研究通过因素分析,将HAMA划分为7个新的分量表:①焦虑体验;②抑郁症状;③躯体神经系症状(简称躯体神经);④内脏器官症状(简称脏器症状);⑤生殖泌尿系症状(简称生殖泌尿);⑥植物神经系症状(简称植物神经);⑦会谈表现。MDD组的抑郁症状因子得分显著高于AD组和OCD组,MDD组和AD组的躯体神经和脏器症状因子得分显著高于OCD组,三组的焦虑体验、会谈表现、生殖泌尿和植物神经因子得分不具有显著性差异。
4.三组患者的血浆5-HT、NE、ACTH、皮质醇和BDNF浓度均无显著性差异。
5.MDD组的人格内外向和神经质得分低于OCD组,主观幸福感得分低于AD组,AD组的复原力得分高于MDD组和OCD组,三组在归因方式、无望感、人格的精神质和自尊方面的差异不显著。
6.三组间的社会功能差异未达到显著性水平。
结论
1.门诊AD和OCD患者抑郁症状程度相似,MDD患者相对较重;AD和MDD患者焦虑、强迫症状程度相似,OCD患者强迫症状相对较重,焦虑相对较轻。焦虑体验、会谈表现、生殖泌尿和植物神经症状是MDD、AD、OCD共有的非特异性症状。
AD症状群=非特异性症状+其他部分焦虑症状(躯体神经和脏器症状);
OCD症状群=非特异性症状+其他部分抑郁症状(认知障碍和绝望)+OCD特异性症状(强迫症状);
MDD症状群=AD症状群+OCD症状群+MDD特异性症状(迟缓和睡眠障碍)-OCD特异性症状(强迫症状)。
2.门诊MDD、AD、OCD患者的血浆5-HT、NE、皮质醇、ACTH、BDNF水平相似,提示三个疾病有相似的生理改变,很难以上述生理指标鉴别疾病。
3.门诊MDD、AD、OCD患者具有相似的归因方式和自尊水平,归因方式和自尊具有类特质的性质,可对三种疾病患者进行归因训练和自尊干预;三种疾病患者的精神质水平相似,MDD患者比OCD患者更加内向,OCD患者比MDD患者更加神经质,人格特质对不同疾病具有病理塑形作用,疾病也可影响人格表现;三种疾病患者的无望感相似,MDD患者比AD患者的主观幸福感少;MDD和OCD患者的复原力不及AD患者,可根据患者不同的复原力水平设计针对性的心理干预策略,有效实现心理治疗的“赋能”作用。
4.门诊MDD、AD、OCD患者的社会功能受损程度相似,本研究希望为社会资源的分配提供参考,完善医疗保险制度。
第二部分团体归因训练和5-羟色胺再回收抑制剂
对不同疾病患者的症状、生理-心理-社会功能作用比较
目的
比较心理治疗和药物治疗对不同疾病患者的症状、生理-心理-社会功能作用,初步探讨心理治疗的神经生物学机制。
方法
采用心理治疗组与药物治疗组对照的前瞻性干预研究设计,系统比较了团体归因训练(Attributional retraining group therapy,ARGT)和5-羟色胺再回收抑制剂(Selective serotonin reuptake inhibitors,SSRI)对不同疾病患者的症状和生理-心理-社会功能作用。根据就诊顺序将MDD、AD、OCD患者分至ARGT组(n=63)或SSRI组(n=66),ARGT组54人,SSRI组55人完成了研究。
所有被试治疗前后测定血浆5-HT、NE、ACTH、皮质醇和BDNF,评定HAMD、HAMA、SDS、SAS、ASQ、SES、EPQ-RSC、CD-RISC、IWB、SDSS,OCD患者加测Yale-Brown强迫量表(Yale-Brownobsessive compulsive scale,Y-BOCS)。治疗中每两周评定一次HAMD和HAMA。
结果
1.两种治疗后的HAMD、HAMA、SDS、SAS总分较治疗前均显著降低。5个时间点的混合效应线性模型结果显示,两组治疗的HAMD总分和HAMA总分得分均无显著性差异。两组治疗都显著降低了Y-BOCS总分、强迫思维得分和强迫行为得分,对强迫症状改善的差异未达到统计学显著水平。
2.两种治疗对HAMD和HAMA分量表症状随时间的改善具有不同的规律:
(1)从整体上看,无论是HAMD还是HAMA,SSRI组2周的改善较ARGT组明显,而ARGT组6、8周的改善较SSRI组明显;
(2)对于HAMD分量表症状:
1) ARGT组的“整体优势因子”为:认知障碍、迟缓、绝望,SSRI组的“整体优势因子”为:日夜变化;
2) ARGT组的“相对首效因子”为:认知障碍、迟缓、绝望(6周)(表2-16),SSRI组的“相对首效因子”为:睡眠障碍和焦虑/躯体化(2周);
3) ARGT对HAMD分量表症状有效改善的顺序为:体重、日夜变化(2周)→睡眠障碍(4周)→焦虑/躯体化、认知障碍、迟缓、绝望(6周);SSRI对HAMD分量表症状有效改善的顺序为:睡眠障碍、焦虑/躯体化、体重、日夜变化(2周)→认知障碍、迟缓、绝望(8周);
(3)对于HAMA分量表症状:
1) ARGT组的“整体优势因子”为:抑郁症状、会谈表现,SSRI组的“整体优势因子”为:焦虑体验;
2) ARGT组无“相对首效因子”,SSRI组的“相对首效因子”为:焦虑体验、抑郁症状、会谈表现、躯体神经、植物神经(2周);
3) ARGT对HAMA分量表症状有效改善的顺序为:脏器症状、生殖泌尿(2周)→焦虑体验、抑郁症状、会谈表现、植物神经(4周)→躯体神经(6周)。SSRI组对HAMA分量表症状的改善无先后顺序:7个因子均最早在2周发生有效改善。
3.ARGT组显著降低了血浆皮质醇水平,SSRI组显著增加了血浆5-HT和BDNF水平;ARGT组在血浆皮质醇水平上的减分显著高于SSRI组。
4.ARGT组心理功能的前后比较在归因方式、无望感、自尊、主观幸福感、复原力、人格的内外向、神经质上均具有统计学显著意义。SSRI组的前后比较在人格的内外向、神经质,复原力和主观幸福感上达到统计学显著差异。ARGT组的归因方式总分和三个维度减分,自尊减分和人格的精神质减分显著高于SSRI组。
5.两组治疗后社会功能均显著改善;ARGT组的SDSS减分显著大于SSRI组。
6.ARGT组5-HT减分与HAMA焦虑减分、社会功能减分呈负相关,NE减分与SAS焦虑减分呈负相关,皮质醇减分与SDS抑郁减分呈正相关,复原力减分与NE、ACTH减分呈正相关;SSRI组5-HT减分与SDS抑郁减分呈负相关,皮质醇减分与人格内外向减分呈正相关。
结论
根据本研究和以往研究结果的讨论,拟得出以下结论:
1.症状方面,心理治疗和药物治疗均可改善患者的抑郁、焦虑、强迫症状。心理治疗起效较慢,药物治疗起效较快。心理治疗对皮质症状的作用较好,药物治疗对皮质下症状的作用较好。
2.神经解剖方面,药物治疗的优势位点可能在皮质下,治疗过程呈现明显的皮质下(2周)到皮质(8周)的自下而上的作用过程;心理治疗的优势位点可能为脑皮质,但不同的阶段和技术可能具有不同的作用位点:情绪稳定技术和认知指导技术带来外周改善(2周)→成长经历分析带来边缘系统和脑干改善(4周)→认知行为技术带来皮质改善(6周)。两种治疗最终都导致了皮质-皮质下脑功能的网络式改变,疾病的恢复来自这种复杂的系统调节,而不是单纯的局部区域改变。
3.神经生理方面,心理治疗可调节血浆皮质醇水平,平衡下丘脑-垂体-肾上腺(hypothalamic-pituitary-adrenal,HPA)轴功能;药物治疗可上调5-HT,通过5-HT能发挥作用。推测两种治疗具有不同的生理作用方式,并通过HPA轴和5-HT能的功能联系相互作用,起到综合的治疗效果。
4.神经可塑性方面,药物治疗通过BDNF的中介作用,影响神经网络的活动依赖性突触可塑性;心理治疗作为一种学习和记忆过程,可能作用于经验依赖性脑可塑性。
5.心理社会功能方面,随着症状的缓解,两种治疗对人格、复原力、主观幸福感、社会功能都有明显改善,心理治疗还可直接作用于归因方式、自尊、人格和社会功能,通过以下四方面作用模式起效:①归因方式的改善;②自尊、人格、复原力的提高;③症状的消除和社会功能的恢复;④无望感的消除和主观幸福感的提高。以上四方面相互作用共同提高患者的心理社会整体功能,良性重构心理特质,有效改善患者的心理易感性。
第三部分团体归因训练对抑郁症、焦虑症、强迫症患者的症状、生理-心理-社会功能作用比较
目的
比较ARGT对MDD、AD和OCD患者的症状、生理-心理-社会功能作用的差别。
方法
采用MDD组、AD组、OCD组相互比较的前瞻性干预研究设计,系统比较了ARGT对门诊MDD(n=19)、AD(n=19)、OCD(n=16)患者的症状、生理-心理-社会功能作用。所有被试治疗前后进行血浆5-HT、NE、ACTH、皮质醇和BDNF的测定,完成24项HAMD、HAMA、SDS、SAS、ASQ、SES、EPQ-RSC、CD-RISC、IWB和SDSS量表的评定。
结果
1.三组的HAMD、HAMA、SDS、SAS、HAMD第21项强迫得分,在ARGT后都有显著减少;MDD组的HAMD减分显著高于OCD组、强迫减分显著高于AD和OCD组。
2.三组被试治疗后的皮质醇水平均较治疗前显著降低;治疗前后三组患者的5种生物学指标减分组间均无显著性差异。
3.治疗后MDD和OCD患者的归因方式三个维度均显著改善,AD患者归因方式的普遍和持续维度显著改善,三组患者的自尊均显著改善。MDD组的无望感、主观幸福感、复原力和人格精神质、内外向均显著改善,AD组的人格神经质、复原力显著改善,OCD组的无望感显著减轻。ARGT对MDD组复原力的作用显著高于AD组和OCD组,对AD组持续归因的作用显著高于MDD组。
4.三组ARGT后社会功能较治疗前均显著改善,ARGT对三组的社会功能减分组间无显著性差异。
结论
1.ARGT对MDD、AD、OCD三种疾病的症状均有明确改善,对三种疾病患者的生理-心理-社会功能均有一定的积极作用。
2.相对而言,ARGT对MDD效果最佳,AD次之,OCD再次。
PartⅠ:Comparison of symptomatology,physiopsychosocial function of major depression disorder,anxiety disorder and obsessive-compulsive disorder
Objective
To compare symptomatology and physiopsychosocial function difference of outpatients with major depression disorder(MDD),anxiety disorder(AD) and obsessive-compulsive disorder(OCD).
Methods
A cross-sectional study design was used to compare symptomatology and physiopsychosocial function of MDD(n=45),AD (n=45),and OCD(n=39) outpatients.Plasma substances were detected including 5-hydroxytryptamine(5-HT),norepinephrine(NE),cortisol, adrenocorticotropic hormone(ACTH),and brain-derived neurotrophic factor(BDNF).Psychosocial function were assessed with Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),self-rating Depression Scale(SDS),self-rating anxiety scale(SAS),attributional style questionnaire(ASQ),Connor-Davidson resilience scale(CD-RISC), the self-esteem scale(SES),index of well-being(IWB),Eysenck personality questionnaire short scale for Chinese(EPQ-RSC),and social disability screening schedule(SDSS).
Results
1.The total scores of HAMD,SDS,SAS in MDD group were higher than AD group and OCD group.The total scores of HAMA in MDD group and AD group were higher than OCD group.The 21th item obsessive compulsive scores of HAMD in OCD group were higher than MDD group and AD group.
2.For HAMD subscales,the MDD group got higher scores on retardation,sleep disturbance and hopelessness subscales than AD group and OCD group.The anxiety subscale scores in MDD group and AD group were higher than OCD group.The cognition disturbance subscale scores in MDD group and OCD group were higher than AD group.OCD group got higher scores on hopelessness subscale than AD group.There were no significant difference on weigh and diurnal variation subscales among the three groups.
3.Seven new subscales were divided by factor analysis,including: (1) anxious emotions,(2) depressed symptoms,(3) somatic nervous symptoms,(4) internal organ symptoms,(5) genito-urinary symptoms,(6) autonomic symptoms,and(7) behavior at interview.The depressed symptoms subscale scored higher in MDD group than AD group and OCD group.The somatic nervous symptoms and internal organ symptoms subscales scores were higher in MDD group and AD group than OCD group.There were no significant differences on anxious emotions,genito-urinary symptoms,autonomic symptoms and behavior at interview subscales among the three groups.
4.No evidence was found of any significant difference in the levels of plasma 5-HT,NE,ACTH,cortisol,and BDNF among the three groups.
5.MDD group got lower scores on extraversion,neuroticism than OCD group and subjective well-being than AD group.The resilience scores were higher in AD group than MDD group and OCD group.There were no significant differences on attributional styles,hopelessness, self-esteem and psychoticism among the three groups.
6.MDD,AD and OCD groups showed similar social function.
Conclusions
1.AD and OCD outpatients share similar depressed symptomatology and MDD outpatients are more serious in that.AD and MDD outpatients share similar anxious and obsessive compulsive symptomatology and OCD outpatients are serious in obsessive compulsive symptomatology and lighter in anxious symptomatology.Anxious emotions,genito-urinary symptoms,autonomic symptoms,and behavior at interview are the non-specific symptoms of MDD,AD and OCD.
AD symptomatology=the non-specific symptoms+some other anxious symptoms(somatic nervous symptoms and internal organ symptoms).
OCD symptomatology=the non-specific symptoms+some other depressed symptoms(cognition disturbance and hopelessness)+the specific OCD symptom(obsessive compulsive symptoms).
MDD symptomatology=AD symptomatology+OCD symptomatology+the specific MDD symptoms(retardation and sleep disturbance)-the specific OCD symptoms(obsessive compulsive symptoms).
2.MDD,AD and OCD outpatients are similar in plasma 5-HT,NE, ACTH,cortisol,and BDNF.A similar physiological basis may exist among the three diseases and it is difficult to distinguish diseases from each other with physiological index.
3.MDD,AD and OCD outpatients are similar in attributional styles and self-esteem,which are trait-similar character.It is feasible to treat the three diseases with attributional retraining(AR) and self-esteem training. Outpatients with the three diseases are similar in psychoticism.MDD outpatients are of more introversion and less neuroticism than OCD outpatients.A vulnerable personality may affect the course and outcome of a disease and itself be a consequence of repeated episodes of illness. The outpatients with three diseases are similar in hopelessness but MDD outpatients feel less subjective well-being than AD patients.MDD and OCD outpatients have less resilience than AD patients.Targeted psychological intervention strategies could be designed according to patients with different resilience level to realize the empowerment role of psychotherapy.
4.Social function impairment of MDD,AD and OCD outpatients are similar to each other.This study can provide reference for allocation of health care resources and improvement of the health insurance system.
PartⅡ:Attributional retraining group therapy versus selective serotonin reuptake inhibitors for different mental disorders:symptomatic and physiopsychosocial effects
Objective
The primary purpose of the present study was to compare the effects on symptomatology and physiopsychosocial function of psychotherapy versus pharmacotherapy for different mental disorders.The secondary purpose was to discuss preliminarily the neurobiological mechanisms of psychotherapy.
Methods
A forward-looking and intervention study design was used to compare psychotherapy and pharmacotherapy.The effects were compared on symptomatology and physiopsychosocial function of attributional retraining group therapy(ARGT) and selective serotonin reuptake inhibitors(SSRI) for different mental disorders.Outpatients were divided into ARGT group(n=63) and SSRI group(n=66) according to the sequence of entering the study.At the end of the study,54 outpatients in ARGT group and 55 outpatients in SSRI group completed the study.
All subjects were detected of plasma 5-HT,NE,cortisol,ACTH and BDNF.Their psychosocial function was assessed with HAMD,HAMA, SDS,SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS. Yale-Brown obsessive compulsive scale(Y-BOCS) was employed only for OCD subjects.
Results
1.After treatment,both ARGT and SSRI groups were found significant reduction on the total scores of HAMD,HAMA,SDS and SAS.With mixed-effects linear model over 5 time points,it was showed that there were no significant differences in the total scores on HAMD and HAMA.Both groups reduced significantly in the total scores on Y-BOCS and obsessive and compulsive symptoms.There was no significant difference in score reduction between the two groups.
2.Different regulations were found of ARGT and SSRI for the changes of HAMD and HAMA subscale symptoms over time:
(1) Overall,SSRI group improved significantly than ARGT group at week 2 and ARGT group yielded well than SSRI group at week 6 and 8;
(2) For HAMD subscale symptoms:
ⅰ) The overall advantage factors of ARGT group were cognition disturbance,retardation and hopelessness.The overall advantage factors of SSRI group was diurnal variation subscales;
ⅱ) The relative first-effect factors of ARGT group were cognition disturbance,retardation and hopelessness at week 6.The relative first-effect factors of SSRI group were sleep disturbance and anxiety at week 2.
ⅲ) The treatment-specific change pattern of ARGT on HAMD subscale symptoms was:weight,diurnal variation(week 2)→sleep disturbance(week 4)→anxiety,cognition disturbance,retardation, hopelessness(week 6).The treatment-specific change pattern of SSRI was:sleep disturbance,anxiety,weight,diurnal variation(week 2)→cognition disturbance,retardation,hopelessness(week 8).
(3) For HAMA subscale symptoms:
ⅰ) The overall advantage factors of ARGT group were depressed symptoms and behavior at interview.The overall advantage factors of SSRI group was anxious emotions subscale;
ⅱ) No the relative first-effect factor was found in ARGT group.The relative first-effect factors of SSRI group were anxious emotions, depressed symptoms,behavior at interview,somatic nervous symptoms and autonomic symptoms at week 2;
ⅲ) The treatment-specific change pattern of ARGT on HAMA subscale symptoms was:internal organ symptoms,genito-urinary symptoms(week 2)→anxious emotions,depressed symptoms,behavior at interview,autonomic symptoms(week 4)→somatic nervous symptoms(week 6).SSRI improved effectively on all HAMA subscales at time 2 simultaneously.
3.After treatment,ARGT group patients decreased plasma cortisol concentrations and SSRI group patients improved plasma 5-HT and BDNF significantly.ARGT group patients showed more reduction in plasma cortisol concentrations than SSRI group.
4.After treatment,changes in ARGT group were significant in attributional styles,hopelessness,self-esteem,subjective well-being, resililence,extraversion,and neuroticism.Changes in SSRI group were significant in subjective well-being,resililence,extraversion,and neuroticism.ARGT group showed more reduction in the scores on attributional styles,self-esteem and psychoticism.
5.Both therapies improved social function significantly.Patients in ARGT group obtained more improvement in social function.
6.In ARGT group,there were negative correlation in the score reduction between 5-HT and HAMA,5-HT and SDSS,NE and SAS,and positive correlation between cortisol and SDS,resilience and NE, resilience and ACTH.In SSRI group,there were negative correlation between 5-HT and SDS and cortisol and extraversion.
Conclusions
Based on results from this study and previous studies,the following conclusions were derived:
1.In aspects of symptomatology,both psychotherapy and pharmacotherapy can reduce depressed,anxiuous and obsessive-compulsive symptomatology.Pharmacotherapy effects eariler than psychotherapy.Psychotherapy yields better in cortical symtoms. Pharmacotherapy yields better in subcortical symtoms.
2.In aspects of neural anatomy,pharmacotherapy may target subcortical regions as the advantage sites with apparent bottom-up treatment-specific change pattern:subcortical regions(week 2) to cortices (week 8).Psychotherapy may target cortices as the advantage sites but seems to target different sites in different phases and techniques: improvement in periphery with emotion regulation skills and cognitive skills(week 2)→improvement in limbic system and brainstem with analysis of growth experience(week 4)→improvement in cortices with cognitive-behavioral skills(week 6).Both therapies result in a net change in cortical-subcortical pathways.The overall modulation of this complex system rather than any one focal regional change may be most critical for diseases remission.
3.In aspects of neurophysiology,psychotherapy can modulate plasma cortisol level,balance hypothalamic-pituitary-adrenal(HPA) axle function.Pharmacotherapy can upmodulate 5-HT level,playing a role through 5-HT function.The two therapies effect by different physiological way.However,both therapies may result in integrated effect by the interaction of HPA axel and 5-HT system.
4.In aspects of neural plasticity,pharmacotherapy can stimulate activity-dependent synaptic plasticity in the neural networks by increasing molecular concentrations of BDNF.As a process of learning and memory,psychotherapy may increase experience-dependent brain plasticity.
5.In aspects of psychosocial function,both therapies can improve personality,resilience,subjective well-being and social function with symptomatic reduction.Besides,psychotherapy can directly focus on attributional styles,self-esteem,personality and social function.The efficacy of psychotherapy may include the following four aspects:(1) changing in attributional styles;(2) improvement in self-esteem, personality and resilience;(3) reduction of symptoms and recovery of social function;(4) elimination of hopelessness and experience of well-being.With an all round improvement in symptomatology and physiopsychosocial function,psychotherapy can help patients positively restructure psychological diathesis and reduce their psychological vulnerability.
PartⅢ:Comparison of symptomatic and physiopsychosocial effects of attribution retraining group therapy for major depression disorder,anxiety disorder and obsessive-compulsive disorder
Objective
To compare the symptomatic and physiopsychosocial effects of ARGT for MDD,AD and OCD.
Methods
A forward-looking and intervention study design was used to compare the symptomatic and physiopsychosocial effects of ARGT for MDD group(n=19),AD group(n=19) and OCD group(n=16).All subjects were detected plasma 5-HT,NE,cortisol,ACTH and BDNF. Their psychosocial functions were assessed with HAMD,HAMA,SDS, SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS.
Results
1.After treatment,all the three groups were found significant reduction on the total scores of HAMD,HAMA,SDS,SAS and the 21th item obsessive compulsive scores of HAMD.MDD group showed more reduction on HAMD than OCD group and obsessive compulsive scores than AD and OCD group.
2.After treatment,all the three groups reduced plasma cortisol concentrations significantly.There was no significant difference in score reduction of 5 plasma substances among the three groups.
3.After ARGT,MDD and OCD patients changed all the three attribution dimensions.GAD patients changed globality and stability attributional styles significantly.ARGT was effective in improving self-esteem for MDD,GAD and OCD patients.In MDD group,ARGT improved significantly in hopelessness,subjective well-being,resilience, psychoticism and extraversion.AD patients obtained significant improvement in resilience and neuroticism.The hopelessness was reduced significantly in OCD patients.
4.All the three groups promoted social function significantly.There was no significant difference in score reduction of SDSS among the three groups.
Conclusions
1.ARGT is an effective psychotherapy for MDD,GAD and OCD.It brings positive improvement in symptomatology and physiopsychosocial function for patients with the three diseases.
2.Comparatively speaking,MDD patients respond best to ARGT, followed by AD patients,and OCD patients obtain least among the three diseases.
目的
比较抑郁症(major depressive disorder,MDD)、焦虑症(anxietydisorder,AD)和强迫症(obsessive-compulsive disorder,OCD)患者在症状、生理-心理-社会功能方面的差别。
方法
采用MDD组、AD组、OCD组比较的横断面研究设计,对45名MDD患者、45名AD患者和39名OCD患者进行了症状、生理-心理-社会功能的比较。生物学指标的检测包括血浆5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(norepinephrine,NE)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)、皮质醇和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)浓度。心理社会功能评估通过以下量表完成:24项汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamiltonanxiety scale,HAMA)、抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-rating anxiety scale,SAS)、归因方式问卷(Attributional style questionnaire,ASQ)、Connor-Davidson韧性量表(Connor-Davidson resilience scale,CD-RISC)、自尊量表(Theself-esteem scale,SES)、主观幸福感指数量表(Index of well-being,IWB)、艾森克人格问卷简式量表中国版(Eysenck personalityquestionnaire short scale for Chinese,EPQ-RSC)、社会功能缺陷筛选量表(Social disability screening schedule,SDSS)。
结果
1.MDD组的HAMD、SDS、SAS总分均显著大于AD组和OCD组,MDD组和AD组的HAMA总分显著大于OCD组,OCD组的HAMD第21项强迫得分显著大于MDD组和AD组。
2.对于HAMD分量表症状,MDD组的迟缓、睡眠障碍、绝望因子得分显著高于AD组和OCD组,MDD组和AD组的焦虑/躯体化因子得分显著高于OCD组,MDD组和OCD组认知障碍因子得分显著大于AD组,OCD组的绝望因子得分显著大于AD组,体重和日夜变化因子三组间差异未达到统计学显著意义。
3.本研究通过因素分析,将HAMA划分为7个新的分量表:①焦虑体验;②抑郁症状;③躯体神经系症状(简称躯体神经);④内脏器官症状(简称脏器症状);⑤生殖泌尿系症状(简称生殖泌尿);⑥植物神经系症状(简称植物神经);⑦会谈表现。MDD组的抑郁症状因子得分显著高于AD组和OCD组,MDD组和AD组的躯体神经和脏器症状因子得分显著高于OCD组,三组的焦虑体验、会谈表现、生殖泌尿和植物神经因子得分不具有显著性差异。
4.三组患者的血浆5-HT、NE、ACTH、皮质醇和BDNF浓度均无显著性差异。
5.MDD组的人格内外向和神经质得分低于OCD组,主观幸福感得分低于AD组,AD组的复原力得分高于MDD组和OCD组,三组在归因方式、无望感、人格的精神质和自尊方面的差异不显著。
6.三组间的社会功能差异未达到显著性水平。
结论
1.门诊AD和OCD患者抑郁症状程度相似,MDD患者相对较重;AD和MDD患者焦虑、强迫症状程度相似,OCD患者强迫症状相对较重,焦虑相对较轻。焦虑体验、会谈表现、生殖泌尿和植物神经症状是MDD、AD、OCD共有的非特异性症状。
AD症状群=非特异性症状+其他部分焦虑症状(躯体神经和脏器症状);
OCD症状群=非特异性症状+其他部分抑郁症状(认知障碍和绝望)+OCD特异性症状(强迫症状);
MDD症状群=AD症状群+OCD症状群+MDD特异性症状(迟缓和睡眠障碍)-OCD特异性症状(强迫症状)。
2.门诊MDD、AD、OCD患者的血浆5-HT、NE、皮质醇、ACTH、BDNF水平相似,提示三个疾病有相似的生理改变,很难以上述生理指标鉴别疾病。
3.门诊MDD、AD、OCD患者具有相似的归因方式和自尊水平,归因方式和自尊具有类特质的性质,可对三种疾病患者进行归因训练和自尊干预;三种疾病患者的精神质水平相似,MDD患者比OCD患者更加内向,OCD患者比MDD患者更加神经质,人格特质对不同疾病具有病理塑形作用,疾病也可影响人格表现;三种疾病患者的无望感相似,MDD患者比AD患者的主观幸福感少;MDD和OCD患者的复原力不及AD患者,可根据患者不同的复原力水平设计针对性的心理干预策略,有效实现心理治疗的“赋能”作用。
4.门诊MDD、AD、OCD患者的社会功能受损程度相似,本研究希望为社会资源的分配提供参考,完善医疗保险制度。
第二部分团体归因训练和5-羟色胺再回收抑制剂
对不同疾病患者的症状、生理-心理-社会功能作用比较
目的
比较心理治疗和药物治疗对不同疾病患者的症状、生理-心理-社会功能作用,初步探讨心理治疗的神经生物学机制。
方法
采用心理治疗组与药物治疗组对照的前瞻性干预研究设计,系统比较了团体归因训练(Attributional retraining group therapy,ARGT)和5-羟色胺再回收抑制剂(Selective serotonin reuptake inhibitors,SSRI)对不同疾病患者的症状和生理-心理-社会功能作用。根据就诊顺序将MDD、AD、OCD患者分至ARGT组(n=63)或SSRI组(n=66),ARGT组54人,SSRI组55人完成了研究。
所有被试治疗前后测定血浆5-HT、NE、ACTH、皮质醇和BDNF,评定HAMD、HAMA、SDS、SAS、ASQ、SES、EPQ-RSC、CD-RISC、IWB、SDSS,OCD患者加测Yale-Brown强迫量表(Yale-Brownobsessive compulsive scale,Y-BOCS)。治疗中每两周评定一次HAMD和HAMA。
结果
1.两种治疗后的HAMD、HAMA、SDS、SAS总分较治疗前均显著降低。5个时间点的混合效应线性模型结果显示,两组治疗的HAMD总分和HAMA总分得分均无显著性差异。两组治疗都显著降低了Y-BOCS总分、强迫思维得分和强迫行为得分,对强迫症状改善的差异未达到统计学显著水平。
2.两种治疗对HAMD和HAMA分量表症状随时间的改善具有不同的规律:
(1)从整体上看,无论是HAMD还是HAMA,SSRI组2周的改善较ARGT组明显,而ARGT组6、8周的改善较SSRI组明显;
(2)对于HAMD分量表症状:
1) ARGT组的“整体优势因子”为:认知障碍、迟缓、绝望,SSRI组的“整体优势因子”为:日夜变化;
2) ARGT组的“相对首效因子”为:认知障碍、迟缓、绝望(6周)(表2-16),SSRI组的“相对首效因子”为:睡眠障碍和焦虑/躯体化(2周);
3) ARGT对HAMD分量表症状有效改善的顺序为:体重、日夜变化(2周)→睡眠障碍(4周)→焦虑/躯体化、认知障碍、迟缓、绝望(6周);SSRI对HAMD分量表症状有效改善的顺序为:睡眠障碍、焦虑/躯体化、体重、日夜变化(2周)→认知障碍、迟缓、绝望(8周);
(3)对于HAMA分量表症状:
1) ARGT组的“整体优势因子”为:抑郁症状、会谈表现,SSRI组的“整体优势因子”为:焦虑体验;
2) ARGT组无“相对首效因子”,SSRI组的“相对首效因子”为:焦虑体验、抑郁症状、会谈表现、躯体神经、植物神经(2周);
3) ARGT对HAMA分量表症状有效改善的顺序为:脏器症状、生殖泌尿(2周)→焦虑体验、抑郁症状、会谈表现、植物神经(4周)→躯体神经(6周)。SSRI组对HAMA分量表症状的改善无先后顺序:7个因子均最早在2周发生有效改善。
3.ARGT组显著降低了血浆皮质醇水平,SSRI组显著增加了血浆5-HT和BDNF水平;ARGT组在血浆皮质醇水平上的减分显著高于SSRI组。
4.ARGT组心理功能的前后比较在归因方式、无望感、自尊、主观幸福感、复原力、人格的内外向、神经质上均具有统计学显著意义。SSRI组的前后比较在人格的内外向、神经质,复原力和主观幸福感上达到统计学显著差异。ARGT组的归因方式总分和三个维度减分,自尊减分和人格的精神质减分显著高于SSRI组。
5.两组治疗后社会功能均显著改善;ARGT组的SDSS减分显著大于SSRI组。
6.ARGT组5-HT减分与HAMA焦虑减分、社会功能减分呈负相关,NE减分与SAS焦虑减分呈负相关,皮质醇减分与SDS抑郁减分呈正相关,复原力减分与NE、ACTH减分呈正相关;SSRI组5-HT减分与SDS抑郁减分呈负相关,皮质醇减分与人格内外向减分呈正相关。
结论
根据本研究和以往研究结果的讨论,拟得出以下结论:
1.症状方面,心理治疗和药物治疗均可改善患者的抑郁、焦虑、强迫症状。心理治疗起效较慢,药物治疗起效较快。心理治疗对皮质症状的作用较好,药物治疗对皮质下症状的作用较好。
2.神经解剖方面,药物治疗的优势位点可能在皮质下,治疗过程呈现明显的皮质下(2周)到皮质(8周)的自下而上的作用过程;心理治疗的优势位点可能为脑皮质,但不同的阶段和技术可能具有不同的作用位点:情绪稳定技术和认知指导技术带来外周改善(2周)→成长经历分析带来边缘系统和脑干改善(4周)→认知行为技术带来皮质改善(6周)。两种治疗最终都导致了皮质-皮质下脑功能的网络式改变,疾病的恢复来自这种复杂的系统调节,而不是单纯的局部区域改变。
3.神经生理方面,心理治疗可调节血浆皮质醇水平,平衡下丘脑-垂体-肾上腺(hypothalamic-pituitary-adrenal,HPA)轴功能;药物治疗可上调5-HT,通过5-HT能发挥作用。推测两种治疗具有不同的生理作用方式,并通过HPA轴和5-HT能的功能联系相互作用,起到综合的治疗效果。
4.神经可塑性方面,药物治疗通过BDNF的中介作用,影响神经网络的活动依赖性突触可塑性;心理治疗作为一种学习和记忆过程,可能作用于经验依赖性脑可塑性。
5.心理社会功能方面,随着症状的缓解,两种治疗对人格、复原力、主观幸福感、社会功能都有明显改善,心理治疗还可直接作用于归因方式、自尊、人格和社会功能,通过以下四方面作用模式起效:①归因方式的改善;②自尊、人格、复原力的提高;③症状的消除和社会功能的恢复;④无望感的消除和主观幸福感的提高。以上四方面相互作用共同提高患者的心理社会整体功能,良性重构心理特质,有效改善患者的心理易感性。
第三部分团体归因训练对抑郁症、焦虑症、强迫症患者的症状、生理-心理-社会功能作用比较
目的
比较ARGT对MDD、AD和OCD患者的症状、生理-心理-社会功能作用的差别。
方法
采用MDD组、AD组、OCD组相互比较的前瞻性干预研究设计,系统比较了ARGT对门诊MDD(n=19)、AD(n=19)、OCD(n=16)患者的症状、生理-心理-社会功能作用。所有被试治疗前后进行血浆5-HT、NE、ACTH、皮质醇和BDNF的测定,完成24项HAMD、HAMA、SDS、SAS、ASQ、SES、EPQ-RSC、CD-RISC、IWB和SDSS量表的评定。
结果
1.三组的HAMD、HAMA、SDS、SAS、HAMD第21项强迫得分,在ARGT后都有显著减少;MDD组的HAMD减分显著高于OCD组、强迫减分显著高于AD和OCD组。
2.三组被试治疗后的皮质醇水平均较治疗前显著降低;治疗前后三组患者的5种生物学指标减分组间均无显著性差异。
3.治疗后MDD和OCD患者的归因方式三个维度均显著改善,AD患者归因方式的普遍和持续维度显著改善,三组患者的自尊均显著改善。MDD组的无望感、主观幸福感、复原力和人格精神质、内外向均显著改善,AD组的人格神经质、复原力显著改善,OCD组的无望感显著减轻。ARGT对MDD组复原力的作用显著高于AD组和OCD组,对AD组持续归因的作用显著高于MDD组。
4.三组ARGT后社会功能较治疗前均显著改善,ARGT对三组的社会功能减分组间无显著性差异。
结论
1.ARGT对MDD、AD、OCD三种疾病的症状均有明确改善,对三种疾病患者的生理-心理-社会功能均有一定的积极作用。
2.相对而言,ARGT对MDD效果最佳,AD次之,OCD再次。
PartⅠ:Comparison of symptomatology,physiopsychosocial function of major depression disorder,anxiety disorder and obsessive-compulsive disorder
Objective
To compare symptomatology and physiopsychosocial function difference of outpatients with major depression disorder(MDD),anxiety disorder(AD) and obsessive-compulsive disorder(OCD).
Methods
A cross-sectional study design was used to compare symptomatology and physiopsychosocial function of MDD(n=45),AD (n=45),and OCD(n=39) outpatients.Plasma substances were detected including 5-hydroxytryptamine(5-HT),norepinephrine(NE),cortisol, adrenocorticotropic hormone(ACTH),and brain-derived neurotrophic factor(BDNF).Psychosocial function were assessed with Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),self-rating Depression Scale(SDS),self-rating anxiety scale(SAS),attributional style questionnaire(ASQ),Connor-Davidson resilience scale(CD-RISC), the self-esteem scale(SES),index of well-being(IWB),Eysenck personality questionnaire short scale for Chinese(EPQ-RSC),and social disability screening schedule(SDSS).
Results
1.The total scores of HAMD,SDS,SAS in MDD group were higher than AD group and OCD group.The total scores of HAMA in MDD group and AD group were higher than OCD group.The 21th item obsessive compulsive scores of HAMD in OCD group were higher than MDD group and AD group.
2.For HAMD subscales,the MDD group got higher scores on retardation,sleep disturbance and hopelessness subscales than AD group and OCD group.The anxiety subscale scores in MDD group and AD group were higher than OCD group.The cognition disturbance subscale scores in MDD group and OCD group were higher than AD group.OCD group got higher scores on hopelessness subscale than AD group.There were no significant difference on weigh and diurnal variation subscales among the three groups.
3.Seven new subscales were divided by factor analysis,including: (1) anxious emotions,(2) depressed symptoms,(3) somatic nervous symptoms,(4) internal organ symptoms,(5) genito-urinary symptoms,(6) autonomic symptoms,and(7) behavior at interview.The depressed symptoms subscale scored higher in MDD group than AD group and OCD group.The somatic nervous symptoms and internal organ symptoms subscales scores were higher in MDD group and AD group than OCD group.There were no significant differences on anxious emotions,genito-urinary symptoms,autonomic symptoms and behavior at interview subscales among the three groups.
4.No evidence was found of any significant difference in the levels of plasma 5-HT,NE,ACTH,cortisol,and BDNF among the three groups.
5.MDD group got lower scores on extraversion,neuroticism than OCD group and subjective well-being than AD group.The resilience scores were higher in AD group than MDD group and OCD group.There were no significant differences on attributional styles,hopelessness, self-esteem and psychoticism among the three groups.
6.MDD,AD and OCD groups showed similar social function.
Conclusions
1.AD and OCD outpatients share similar depressed symptomatology and MDD outpatients are more serious in that.AD and MDD outpatients share similar anxious and obsessive compulsive symptomatology and OCD outpatients are serious in obsessive compulsive symptomatology and lighter in anxious symptomatology.Anxious emotions,genito-urinary symptoms,autonomic symptoms,and behavior at interview are the non-specific symptoms of MDD,AD and OCD.
AD symptomatology=the non-specific symptoms+some other anxious symptoms(somatic nervous symptoms and internal organ symptoms).
OCD symptomatology=the non-specific symptoms+some other depressed symptoms(cognition disturbance and hopelessness)+the specific OCD symptom(obsessive compulsive symptoms).
MDD symptomatology=AD symptomatology+OCD symptomatology+the specific MDD symptoms(retardation and sleep disturbance)-the specific OCD symptoms(obsessive compulsive symptoms).
2.MDD,AD and OCD outpatients are similar in plasma 5-HT,NE, ACTH,cortisol,and BDNF.A similar physiological basis may exist among the three diseases and it is difficult to distinguish diseases from each other with physiological index.
3.MDD,AD and OCD outpatients are similar in attributional styles and self-esteem,which are trait-similar character.It is feasible to treat the three diseases with attributional retraining(AR) and self-esteem training. Outpatients with the three diseases are similar in psychoticism.MDD outpatients are of more introversion and less neuroticism than OCD outpatients.A vulnerable personality may affect the course and outcome of a disease and itself be a consequence of repeated episodes of illness. The outpatients with three diseases are similar in hopelessness but MDD outpatients feel less subjective well-being than AD patients.MDD and OCD outpatients have less resilience than AD patients.Targeted psychological intervention strategies could be designed according to patients with different resilience level to realize the empowerment role of psychotherapy.
4.Social function impairment of MDD,AD and OCD outpatients are similar to each other.This study can provide reference for allocation of health care resources and improvement of the health insurance system.
PartⅡ:Attributional retraining group therapy versus selective serotonin reuptake inhibitors for different mental disorders:symptomatic and physiopsychosocial effects
Objective
The primary purpose of the present study was to compare the effects on symptomatology and physiopsychosocial function of psychotherapy versus pharmacotherapy for different mental disorders.The secondary purpose was to discuss preliminarily the neurobiological mechanisms of psychotherapy.
Methods
A forward-looking and intervention study design was used to compare psychotherapy and pharmacotherapy.The effects were compared on symptomatology and physiopsychosocial function of attributional retraining group therapy(ARGT) and selective serotonin reuptake inhibitors(SSRI) for different mental disorders.Outpatients were divided into ARGT group(n=63) and SSRI group(n=66) according to the sequence of entering the study.At the end of the study,54 outpatients in ARGT group and 55 outpatients in SSRI group completed the study.
All subjects were detected of plasma 5-HT,NE,cortisol,ACTH and BDNF.Their psychosocial function was assessed with HAMD,HAMA, SDS,SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS. Yale-Brown obsessive compulsive scale(Y-BOCS) was employed only for OCD subjects.
Results
1.After treatment,both ARGT and SSRI groups were found significant reduction on the total scores of HAMD,HAMA,SDS and SAS.With mixed-effects linear model over 5 time points,it was showed that there were no significant differences in the total scores on HAMD and HAMA.Both groups reduced significantly in the total scores on Y-BOCS and obsessive and compulsive symptoms.There was no significant difference in score reduction between the two groups.
2.Different regulations were found of ARGT and SSRI for the changes of HAMD and HAMA subscale symptoms over time:
(1) Overall,SSRI group improved significantly than ARGT group at week 2 and ARGT group yielded well than SSRI group at week 6 and 8;
(2) For HAMD subscale symptoms:
ⅰ) The overall advantage factors of ARGT group were cognition disturbance,retardation and hopelessness.The overall advantage factors of SSRI group was diurnal variation subscales;
ⅱ) The relative first-effect factors of ARGT group were cognition disturbance,retardation and hopelessness at week 6.The relative first-effect factors of SSRI group were sleep disturbance and anxiety at week 2.
ⅲ) The treatment-specific change pattern of ARGT on HAMD subscale symptoms was:weight,diurnal variation(week 2)→sleep disturbance(week 4)→anxiety,cognition disturbance,retardation, hopelessness(week 6).The treatment-specific change pattern of SSRI was:sleep disturbance,anxiety,weight,diurnal variation(week 2)→cognition disturbance,retardation,hopelessness(week 8).
(3) For HAMA subscale symptoms:
ⅰ) The overall advantage factors of ARGT group were depressed symptoms and behavior at interview.The overall advantage factors of SSRI group was anxious emotions subscale;
ⅱ) No the relative first-effect factor was found in ARGT group.The relative first-effect factors of SSRI group were anxious emotions, depressed symptoms,behavior at interview,somatic nervous symptoms and autonomic symptoms at week 2;
ⅲ) The treatment-specific change pattern of ARGT on HAMA subscale symptoms was:internal organ symptoms,genito-urinary symptoms(week 2)→anxious emotions,depressed symptoms,behavior at interview,autonomic symptoms(week 4)→somatic nervous symptoms(week 6).SSRI improved effectively on all HAMA subscales at time 2 simultaneously.
3.After treatment,ARGT group patients decreased plasma cortisol concentrations and SSRI group patients improved plasma 5-HT and BDNF significantly.ARGT group patients showed more reduction in plasma cortisol concentrations than SSRI group.
4.After treatment,changes in ARGT group were significant in attributional styles,hopelessness,self-esteem,subjective well-being, resililence,extraversion,and neuroticism.Changes in SSRI group were significant in subjective well-being,resililence,extraversion,and neuroticism.ARGT group showed more reduction in the scores on attributional styles,self-esteem and psychoticism.
5.Both therapies improved social function significantly.Patients in ARGT group obtained more improvement in social function.
6.In ARGT group,there were negative correlation in the score reduction between 5-HT and HAMA,5-HT and SDSS,NE and SAS,and positive correlation between cortisol and SDS,resilience and NE, resilience and ACTH.In SSRI group,there were negative correlation between 5-HT and SDS and cortisol and extraversion.
Conclusions
Based on results from this study and previous studies,the following conclusions were derived:
1.In aspects of symptomatology,both psychotherapy and pharmacotherapy can reduce depressed,anxiuous and obsessive-compulsive symptomatology.Pharmacotherapy effects eariler than psychotherapy.Psychotherapy yields better in cortical symtoms. Pharmacotherapy yields better in subcortical symtoms.
2.In aspects of neural anatomy,pharmacotherapy may target subcortical regions as the advantage sites with apparent bottom-up treatment-specific change pattern:subcortical regions(week 2) to cortices (week 8).Psychotherapy may target cortices as the advantage sites but seems to target different sites in different phases and techniques: improvement in periphery with emotion regulation skills and cognitive skills(week 2)→improvement in limbic system and brainstem with analysis of growth experience(week 4)→improvement in cortices with cognitive-behavioral skills(week 6).Both therapies result in a net change in cortical-subcortical pathways.The overall modulation of this complex system rather than any one focal regional change may be most critical for diseases remission.
3.In aspects of neurophysiology,psychotherapy can modulate plasma cortisol level,balance hypothalamic-pituitary-adrenal(HPA) axle function.Pharmacotherapy can upmodulate 5-HT level,playing a role through 5-HT function.The two therapies effect by different physiological way.However,both therapies may result in integrated effect by the interaction of HPA axel and 5-HT system.
4.In aspects of neural plasticity,pharmacotherapy can stimulate activity-dependent synaptic plasticity in the neural networks by increasing molecular concentrations of BDNF.As a process of learning and memory,psychotherapy may increase experience-dependent brain plasticity.
5.In aspects of psychosocial function,both therapies can improve personality,resilience,subjective well-being and social function with symptomatic reduction.Besides,psychotherapy can directly focus on attributional styles,self-esteem,personality and social function.The efficacy of psychotherapy may include the following four aspects:(1) changing in attributional styles;(2) improvement in self-esteem, personality and resilience;(3) reduction of symptoms and recovery of social function;(4) elimination of hopelessness and experience of well-being.With an all round improvement in symptomatology and physiopsychosocial function,psychotherapy can help patients positively restructure psychological diathesis and reduce their psychological vulnerability.
PartⅢ:Comparison of symptomatic and physiopsychosocial effects of attribution retraining group therapy for major depression disorder,anxiety disorder and obsessive-compulsive disorder
Objective
To compare the symptomatic and physiopsychosocial effects of ARGT for MDD,AD and OCD.
Methods
A forward-looking and intervention study design was used to compare the symptomatic and physiopsychosocial effects of ARGT for MDD group(n=19),AD group(n=19) and OCD group(n=16).All subjects were detected plasma 5-HT,NE,cortisol,ACTH and BDNF. Their psychosocial functions were assessed with HAMD,HAMA,SDS, SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS.
Results
1.After treatment,all the three groups were found significant reduction on the total scores of HAMD,HAMA,SDS,SAS and the 21th item obsessive compulsive scores of HAMD.MDD group showed more reduction on HAMD than OCD group and obsessive compulsive scores than AD and OCD group.
2.After treatment,all the three groups reduced plasma cortisol concentrations significantly.There was no significant difference in score reduction of 5 plasma substances among the three groups.
3.After ARGT,MDD and OCD patients changed all the three attribution dimensions.GAD patients changed globality and stability attributional styles significantly.ARGT was effective in improving self-esteem for MDD,GAD and OCD patients.In MDD group,ARGT improved significantly in hopelessness,subjective well-being,resilience, psychoticism and extraversion.AD patients obtained significant improvement in resilience and neuroticism.The hopelessness was reduced significantly in OCD patients.
4.All the three groups promoted social function significantly.There was no significant difference in score reduction of SDSS among the three groups.
Conclusions
1.ARGT is an effective psychotherapy for MDD,GAD and OCD.It brings positive improvement in symptomatology and physiopsychosocial function for patients with the three diseases.
2.Comparatively speaking,MDD patients respond best to ARGT, followed by AD patients,and OCD patients obtain least among the three diseases.
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