汶川震后孤儿创伤后应激障碍认知行为治疗的初步观察
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摘要
目的:对汶川震后的创伤后应激障碍(PTSD)孤儿进行心理干预,探讨认知行为治疗技术的效果。方法:选取汶川地震11个月后的创伤后应激障碍患儿12例,均为孤儿(年龄11～15岁),其中1例脱落,5例完成了每周1次共8次的团体心理治疗,6例完成了每周1～2次共8次的个体心理治疗。采用事件影响量表(IES)、心理治疗效果评定量表(FEP)、UCLA孤独量表、焦虑自评量表(SAS)和自尊量表(SES)在治疗前、治疗后及3年后随访时进行评定。结果:治疗后11例患儿的PTSD症状均明显缓解,随访时症状无反复,IES总分治疗前、治疗后及随访时逐次降低[(31.6±10.2)vs.(18.2±10.3)vs.(9.0±2.8),均P<0.001];FEP量表总分、SAS焦虑量表和UCLA孤独量表得分治疗后均低于治疗前[(45.7±16.4)vs.(67.1±23.2),(40.3±9.2)vs.(50.1±10.3),(44.2±8.2)vs.(51.4±10.5);均P<0.05],随访时与治疗结束时比较差异无统计学意义(P>0.05)。SES评分治疗前、治疗后及随访时逐次升高[(24.6±3.3)vs.(27.9±4.1)vs.(31.8±2.8),均P<0.05]。结论:本研究提示,认知行为治疗适用于地震灾后应激障碍儿童少年,效果良好。
Objective:To examine the effects of cognitive-behavioral therapy(CBT) in orphans with post-traumatic stress disorder(PTSD) symptoms following the Wenchuan earthquake of 2008.Methods:The subjects in this study consisted of 12 orphans,aged 11-15 years,who experienced PTSD 11 months after the Wenchuan earthquake of 2008.In the study,1 subject dropped out,5 received cognitive behavioral group intervention once a week(total 8 times),while the other 6 received cognitive behavioral individual intervention once or twice a week(total 8 times).They were assessed with the Impact of Event Scale(IES),Fragebogen zur Erfassung klinisch bedeutsamer Vernderungen im Psychotherapieverlauf(FEP),Self Rating Anxiety Scale(SAS),UCLA Loneliness Scale and Self-Esteem Scale(SES) before and after treatment,and after 3 years.Results:The PTSD symptoms of children were significantly relieved after the treatment,and there were no repeated illness after 3 years.The IES total scores reduced gradually along with the time in 11 orphans [(31.6±10.2) vs.(18.2±10.3) vs.(9.0±2.8),P<0.001].Compared with pretreatment,the scores of the FEP [(45.7±16.4) vs.(67.1±23.2)],SAS [(40.3±9.2) vs.(50.1±10.3)] and UCLA [(44.2±8.2) vs.(51.4±10.5)] decreased after treatment(Ps<0.05),and there were no significant changes between the 3-year follow-up and the end of treatment.The SES scores increased gradually along with the time [(24.6±3.3) vs.(27.9±4.1) vs.(31.8±2.8),P<0.05].Conclusion:It suggests that the cognitive-behavioral therapy appears to be applicable and effective for children with posttraumatic stress disorder after earthquake.
Objective:To examine the effects of cognitive-behavioral therapy(CBT) in orphans with post-traumatic stress disorder(PTSD) symptoms following the Wenchuan earthquake of 2008.Methods:The subjects in this study consisted of 12 orphans,aged 11-15 years,who experienced PTSD 11 months after the Wenchuan earthquake of 2008.In the study,1 subject dropped out,5 received cognitive behavioral group intervention once a week(total 8 times),while the other 6 received cognitive behavioral individual intervention once or twice a week(total 8 times).They were assessed with the Impact of Event Scale(IES),Fragebogen zur Erfassung klinisch bedeutsamer Vernderungen im Psychotherapieverlauf(FEP),Self Rating Anxiety Scale(SAS),UCLA Loneliness Scale and Self-Esteem Scale(SES) before and after treatment,and after 3 years.Results:The PTSD symptoms of children were significantly relieved after the treatment,and there were no repeated illness after 3 years.The IES total scores reduced gradually along with the time in 11 orphans [(31.6±10.2) vs.(18.2±10.3) vs.(9.0±2.8),P<0.001].Compared with pretreatment,the scores of the FEP [(45.7±16.4) vs.(67.1±23.2)],SAS [(40.3±9.2) vs.(50.1±10.3)] and UCLA [(44.2±8.2) vs.(51.4±10.5)] decreased after treatment(Ps<0.05),and there were no significant changes between the 3-year follow-up and the end of treatment.The SES scores increased gradually along with the time [(24.6±3.3) vs.(27.9±4.1) vs.(31.8±2.8),P<0.05].Conclusion:It suggests that the cognitive-behavioral therapy appears to be applicable and effective for children with posttraumatic stress disorder after earthquake.
引文
[1]Brew in CR,Dalgleish T,Joseph S.A dual representation theory ofposttraumatic stress disorder[J].Psychol Rev,1996,103(4):670-686.
[2]沈渔邨.精神病学[M].5版.北京:人民卫生出版社,2009:622-625.
[3]Yehuda R.Treating trauma survivors w ith PTSD[M].WashingtonDC:American Psychiatric Publishing,2002:63-74.
[4]Nixon RD,Sterk J,Pearce A.A randomized trial of cognitive be-havior therapy and cognitive therapy for children w ith posttraumaticstress disorder follow ing single-incident trauma[J].J AbnormChild Psychol,2012,40(3):327-337.
[5]世界卫生组织.ICD-10精神与行为障碍分类:临床描述与诊断要点[M].范肖冬,汪向东,于欣,等,译.北京:人民卫生出版社:1993:119-120.
[6]赵丞智,汪向东,常连玺,等.事件影响量表的信度、效度分析[J].中国心理卫生杂志,2003,17(10):679-681.
[7]Zarbock G,Wang XL,Drew s M,et al.Monitoring psychotherapeu-tic change:Psychometric Evaluation of Short-Form Outcome Ques-tionnaires in China and Germany[J].Acta Psychol Sin,2007,39(5):880-891.
[8]刘平.UCLA孤独量表(UCLA Lonliness Scale)[J].中国心理卫生杂志,1999,(增刊):284-287.
[9]吴文源.焦虑自评量表(Self-Rating Anxiety Scale,SAS)[J].中国心理卫生杂志,1999,(增刊):235-238.
[10]季益富,于欣.自尊量表(The self-Esteem Scale,SES)[J].中国心理卫生杂志,1999,(增刊):318-320.
[11]Gall-Peters A,Zarbock G.Praxisleitfaden verhaltenstherapie:sto¨ru-ngsspezifische strategien,therapieindividualisierung,patienteninfor-mationen[M].Pabst Science Publishers,Lengerich,2011:326-380.
[12]Lhre A.The impact of loneliness on self-rated health symptoms a-mong victimized school children[J].Child Adolesc PsychiatryMent Health,2012,6(1):20.doi:10.1186/1753-2000-6-20.
[13]Solomon Z,Dekel R.The contribution of loneliness and posttrau-matic stress disorder to marital adjustment follow ing w ar captivity:a longitudinal study[J].Fam Process,2008,47(2):261-275.
[14]张本,王学义,孙贺祥,等.唐山大地震孤儿远期心身健康的调查研究[J].中国心理卫生杂志,2000,14(1):17-19.
[15]王丽萍,张本,姜涛.唐山地震孤儿30年后心理健康状况调查[J].中国心理卫生杂志,2009,23(8):558-563.
[16]Boscarino JA,Adams RE.PTSD onset and course follow ing theWorld Trade Center disaster:findings and implications for future re-search[J].Soc Psychiatry Psychiatr Epidemiol,2009,44(10):887-898.
[17]Robinaugh DJ,McNally RJ.Trauma centrality and PTSD symptomseverity in adult survivors of childhood sexual abuse[J].J TraumaStress,2011,24(4):483-486.
[18]张本,王学义,孙贺祥,等.唐山大地震对人类心身健康远期影响[J].中国心理卫生杂志,1998,12(4):200-202.
[2]沈渔邨.精神病学[M].5版.北京:人民卫生出版社,2009:622-625.
[3]Yehuda R.Treating trauma survivors w ith PTSD[M].WashingtonDC:American Psychiatric Publishing,2002:63-74.
[4]Nixon RD,Sterk J,Pearce A.A randomized trial of cognitive be-havior therapy and cognitive therapy for children w ith posttraumaticstress disorder follow ing single-incident trauma[J].J AbnormChild Psychol,2012,40(3):327-337.
[5]世界卫生组织.ICD-10精神与行为障碍分类:临床描述与诊断要点[M].范肖冬,汪向东,于欣,等,译.北京:人民卫生出版社:1993:119-120.
[6]赵丞智,汪向东,常连玺,等.事件影响量表的信度、效度分析[J].中国心理卫生杂志,2003,17(10):679-681.
[7]Zarbock G,Wang XL,Drew s M,et al.Monitoring psychotherapeu-tic change:Psychometric Evaluation of Short-Form Outcome Ques-tionnaires in China and Germany[J].Acta Psychol Sin,2007,39(5):880-891.
[8]刘平.UCLA孤独量表(UCLA Lonliness Scale)[J].中国心理卫生杂志,1999,(增刊):284-287.
[9]吴文源.焦虑自评量表(Self-Rating Anxiety Scale,SAS)[J].中国心理卫生杂志,1999,(增刊):235-238.
[10]季益富,于欣.自尊量表(The self-Esteem Scale,SES)[J].中国心理卫生杂志,1999,(增刊):318-320.
[11]Gall-Peters A,Zarbock G.Praxisleitfaden verhaltenstherapie:sto¨ru-ngsspezifische strategien,therapieindividualisierung,patienteninfor-mationen[M].Pabst Science Publishers,Lengerich,2011:326-380.
[12]Lhre A.The impact of loneliness on self-rated health symptoms a-mong victimized school children[J].Child Adolesc PsychiatryMent Health,2012,6(1):20.doi:10.1186/1753-2000-6-20.
[13]Solomon Z,Dekel R.The contribution of loneliness and posttrau-matic stress disorder to marital adjustment follow ing w ar captivity:a longitudinal study[J].Fam Process,2008,47(2):261-275.
[14]张本,王学义,孙贺祥,等.唐山大地震孤儿远期心身健康的调查研究[J].中国心理卫生杂志,2000,14(1):17-19.
[15]王丽萍,张本,姜涛.唐山地震孤儿30年后心理健康状况调查[J].中国心理卫生杂志,2009,23(8):558-563.
[16]Boscarino JA,Adams RE.PTSD onset and course follow ing theWorld Trade Center disaster:findings and implications for future re-search[J].Soc Psychiatry Psychiatr Epidemiol,2009,44(10):887-898.
[17]Robinaugh DJ,McNally RJ.Trauma centrality and PTSD symptomseverity in adult survivors of childhood sexual abuse[J].J TraumaStress,2011,24(4):483-486.
[18]张本,王学义,孙贺祥,等.唐山大地震对人类心身健康远期影响[J].中国心理卫生杂志,1998,12(4):200-202.
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