Inference-Based Approach versus Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder with Poor Insight: A 24-Session Randomized Controlled Trial
Inference-Based Approach versus Cognitive Behavioral Therapy in the Treatment of Obsessive-Compulsive Disorder with Poor Insight: A 24-Session Randomized Controlled Trial
复制标题
DOI：
10.1159/000382131
复制
发表时间：
2015-01-01
影响因子：
22.8
通讯作者：
van Balkom, Anton J.
中科院分区：
文献类型：
--
作者：
Visser, Henny A.;van Megen, Harold;van Balkom, Anton J.
目的：具有低洞察力的强迫症（OCD）对患者有严重的后果;然而，还没有进行随机对照试验来评估任何专门针对低洞察力强迫症的治疗的有效性。一种新的心理治疗强迫症，推理为基础的方法（IBA），通过加强正常的感觉驱动的现实测试的目标在强迫症的洞察力。本研究的目的是比较这种新疗法与认知行为疗法（CBT）对自知力差的强迫症患者的有效性。方法：进行了一项随机对照试验，其中90例自知力差的强迫症患者接受了24次CBT或24次IBA治疗。主要结果测量是耶鲁-布朗强迫量表（YBOCS）。次要结果指标为自知力水平、焦虑和抑郁症状以及生活质量。混合效应模型用于确定治疗效果。结果：在这两种情况下，一个显着的强迫症症状减轻达到，但没有条件的影响。事后，在最差自知力患者的一个小亚组（n = 23）中，发现接受IBA治疗的患者的OCD症状减轻程度显著高于接受CBT治疗的患者[估计边缘均值=-7.77，t（219.45）=-2.4，p = 0.017]。结论：自知力差的强迫症患者经心理治疗后，自知力明显改善。本研究的结果表明，CBT和IBA都是治疗洞察力较差的强迫症的有效治疗方法。对于更极端的自知力差的患者，IBA可能比CBT更有希望。(C)2015 S. Karger AG，巴塞尔
Objective: Obsessive-compulsive disorder (OCD) with poor insight has severe consequences for patients; nonetheless, no randomized controlled trial has ever been performed to evaluate the effectiveness of any treatment specifically for poor-insight OCD. A new psychotherapy for OCD, the inference-based approach (IBA), targets insight in OCD by strengthening normal sensory-driven reality testing. The goal of the present study is to compare the effectiveness of this new treatment to the effectiveness of cognitive behavior therapy (CBT) for patients with OCD with poor insight. Method: A randomized controlled trial was conducted, in which 90 patients with OCD with poor insight received either 24 CBT sessions or 24 IBA sessions. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS). Secondary outcome measures were level of insight, anxiety and depressive symptoms, and quality of life. Mixed-effects models were used to determine the treatment effect. Results: In both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than the patients treated with CBT [estimated marginal mean = -7.77, t(219.45) = -2.4, p = 0.017]. Conclusion: Patients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight. (C) 2015 S. Karger AG, Basel