团体现实疗法对首发轻中度广泛性焦虑障碍患者的疗效
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摘要
目的:探讨团体现实疗法对首发轻中度广泛性焦虑障碍(GAD)患者的疗效。方法:采用前瞻性对照研究方法,将69名GAD患者随机分为治疗组和对照组,治疗组参加8周团体现实疗法治疗,两组在基线与8周后分别测评汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、内控性、有势力的他人及机遇量表(IPCS)、应付方式问卷、自尊量表(SES)和幸福感指数;此外,治疗组在第2、4、6周复测HAMA。结果:8周后治疗组HAMA总分和分量表分均明显低于对照组(P<0.01));"内控性"、应付方式中"解决问题"和"求助"、SES及幸福感指数评分均显著高于对照组,"有势力的他人"、"退避"评分显著低于对照组(P<0.05)。与基线评分相比,治疗组HAMA总分和精神性焦虑从第2周显著减低(P<0.05),躯体性焦虑从第4周显著降低(P<0.05)。结论:团体现实疗法对轻中度GAD患者的焦虑症状疗效显著,精神焦虑改善早于躯体焦虑症状,患者内控力、积极应对方式的应用、自尊和幸福感均提高。
Objective: To explore the effects of group reality therapy for the first episode patients with mild to moderate generalized anxiety disorder(GAD). Methods: Sixty-nine patients with first-onset mild to moderate GAD were randomly divided into the therapy group and the control group. The therapy group attended group reality therapy for 8 weeks, all the participants were measured at baseline and 8 weeks later respectively using Hamilton anxiety Scale(HAMA), Hamilton depression Scale(HAMD), Internality, Powerful Others and Chance Scale(IPCS), Coping Style Questionnaire, self-esteem Scale(SES), and well-being index. All the participants were tested by HAMA in the second, fourth, sixth week respectively. Results: Compared with the scores of the two groups after 8 weeks, the scores of HAMA and psychiatric anxiety and somatic anxiety were significantly lower than the control group(P<0.01); the internality score of IPCS, the solving problem and seeking help scores of Coping Style Questionnaire, SES and well-being scores of the therapy group were significantly higher than the control group(P<0.05), while the Powerful Others score of IPCS, the withdrawal score of Coping Style Questionnaire of the therapy group were significantly lower than the control group(P<0.05). The scores of HAMA and psychogenic anxiety decreased significantly from the second week(P<0.05), while somatic anxiety score decreased significantly from the fourth week(P<0.05). Conclusion: Group reality therapy is effective for the treatment of anxiety symptoms in patients with mild to moderate GAD. The development of psychogenic anxiety is earlier than somatic anxiety. After treatment, the internal control ability of the patient improved, and they adopt more positive coping style, and their self-esteem and happiness & life satisfaction also increase.
Objective: To explore the effects of group reality therapy for the first episode patients with mild to moderate generalized anxiety disorder(GAD). Methods: Sixty-nine patients with first-onset mild to moderate GAD were randomly divided into the therapy group and the control group. The therapy group attended group reality therapy for 8 weeks, all the participants were measured at baseline and 8 weeks later respectively using Hamilton anxiety Scale(HAMA), Hamilton depression Scale(HAMD), Internality, Powerful Others and Chance Scale(IPCS), Coping Style Questionnaire, self-esteem Scale(SES), and well-being index. All the participants were tested by HAMA in the second, fourth, sixth week respectively. Results: Compared with the scores of the two groups after 8 weeks, the scores of HAMA and psychiatric anxiety and somatic anxiety were significantly lower than the control group(P<0.01); the internality score of IPCS, the solving problem and seeking help scores of Coping Style Questionnaire, SES and well-being scores of the therapy group were significantly higher than the control group(P<0.05), while the Powerful Others score of IPCS, the withdrawal score of Coping Style Questionnaire of the therapy group were significantly lower than the control group(P<0.05). The scores of HAMA and psychogenic anxiety decreased significantly from the second week(P<0.05), while somatic anxiety score decreased significantly from the fourth week(P<0.05). Conclusion: Group reality therapy is effective for the treatment of anxiety symptoms in patients with mild to moderate GAD. The development of psychogenic anxiety is earlier than somatic anxiety. After treatment, the internal control ability of the patient improved, and they adopt more positive coping style, and their self-esteem and happiness & life satisfaction also increase.
引文
1 Guo X,Meng Z,Huang G,et al.Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to2015.Scientific Reports,2016,6:28033
2张亚林,杨峘.焦虑障碍的心理治疗.中华精神科杂志,2015,48(4):196-198
3 Glasser W.Reality therapy.New York:Harpen&Row,1965
4 Glasser W.Counseling with Choice Theory:The New Reality Therapy.Spring,Institute Newsleter,2005
5 Joseph Scott Bean.The effect of individualized reality therapy on the recidivism rates and locus of control orientation of male juvenile offenders.Oxford,The University of Mississippi,1988
6 Robert Manning Edens.Effects of teaching control theory and reality therapy as an approach to reducing disruptive behaviors in middle school physical education.Greensboro:The University of North Carolina,1995
7 William John Abbott.The effect of reality therapy-based group counseling on the self-esteem of learning disabled sixth,seventh,and eighth graders.Charlottesville:The University of Virginia,1983
8 Lynn Wood Brandon.The effect of a reality therapy treatment upon students’absenteeism and locus of control of reinforcement.Atlanta:Georgia State University,1981
9 Robert E.Wubbolding,John Brickell,Lothar Lmhof,et al.Reality Therapy:A Global Perspective.International Journal for the Advancement of Counselling,2004,26(3):219-228
10 Glasser W.Choice theory:A New Psychology of Personal Freedom.New York:Harper Collins,1998
11 Sheryl Prenzlau.Using Reality Therapy to Reduce PTSD-Related Symptoms.International Journal of Reality Therapy,2006,25(2):23-29
12曾琬雅,张高宾.现实治疗团体对受霸凌青少年忧郁之辅导效果--以台湾某初中为例.青年探索,2011,166(3):23-29
13 Scott D.Reeder.Choice theory:An investigation of the treatment effects of a choice theory protocol on students identified as having a behavioral or emotional disability on measures of anxiety,depression,locus of control and selfesteem.Charlotte:The University of North Carolina,2011
14吴晓宇.现实治疗取向的团体治疗对住院焦虑症患者的疗效研究.苏州:苏州大学,2007
15 APA.Diagnostic and statistical manual of mental disorders:DSM-IV.4th ed.Washington DC:American Psychiatric Association,1994
16汪向东,王西林,马弘.心理卫生评定量表手册.中国心理卫生杂志,1999
17王纯.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.长沙:中南大学湘雅二医院精神卫生研究所,2009.55-58
18 Carol Ann Houston-Slowik.The effect of reality therapy processes on locus of control and dimensions of self-concept in the school setting of Mexican-American seventh and ninth grade students.Houston,The University of Houston,1982
19 Roddenberry A,Renk K.Locus of control and self-efficacy:potential mediators of stress,illness,and utilization of health services in college students.Child Psychiatry and Human Development,2010,41(4):353-370
20 Gale CR,Batty GD,Deary IJ.Locus of control at age 10years and health outcomes and behaviors at age 30 years:the1970 British Cohort Study.Psychosomatic Medicine,2008,70(4):397-403
21 Glasser W.A new look at school failure and school success.The Phi Delta Kappan,1997,78(8):596-602
22 Mann M,Hosman CMH,Schaalma HP,de Vries NK.Selfesteem in a broad-spectrum approach for mental health promotion.Health Education Research,2004,19(4):357-372
23 Greenberg J,Solomon S,Pyszczynski T,et al.Why do people need self-esteem?Converging evidence that self-esteem serves an anxiety-buffering function.Journal of Personality and Social Psychology,1992,63(6):913-922
2张亚林,杨峘.焦虑障碍的心理治疗.中华精神科杂志,2015,48(4):196-198
3 Glasser W.Reality therapy.New York:Harpen&Row,1965
4 Glasser W.Counseling with Choice Theory:The New Reality Therapy.Spring,Institute Newsleter,2005
5 Joseph Scott Bean.The effect of individualized reality therapy on the recidivism rates and locus of control orientation of male juvenile offenders.Oxford,The University of Mississippi,1988
6 Robert Manning Edens.Effects of teaching control theory and reality therapy as an approach to reducing disruptive behaviors in middle school physical education.Greensboro:The University of North Carolina,1995
7 William John Abbott.The effect of reality therapy-based group counseling on the self-esteem of learning disabled sixth,seventh,and eighth graders.Charlottesville:The University of Virginia,1983
8 Lynn Wood Brandon.The effect of a reality therapy treatment upon students’absenteeism and locus of control of reinforcement.Atlanta:Georgia State University,1981
9 Robert E.Wubbolding,John Brickell,Lothar Lmhof,et al.Reality Therapy:A Global Perspective.International Journal for the Advancement of Counselling,2004,26(3):219-228
10 Glasser W.Choice theory:A New Psychology of Personal Freedom.New York:Harper Collins,1998
11 Sheryl Prenzlau.Using Reality Therapy to Reduce PTSD-Related Symptoms.International Journal of Reality Therapy,2006,25(2):23-29
12曾琬雅,张高宾.现实治疗团体对受霸凌青少年忧郁之辅导效果--以台湾某初中为例.青年探索,2011,166(3):23-29
13 Scott D.Reeder.Choice theory:An investigation of the treatment effects of a choice theory protocol on students identified as having a behavioral or emotional disability on measures of anxiety,depression,locus of control and selfesteem.Charlotte:The University of North Carolina,2011
14吴晓宇.现实治疗取向的团体治疗对住院焦虑症患者的疗效研究.苏州:苏州大学,2007
15 APA.Diagnostic and statistical manual of mental disorders:DSM-IV.4th ed.Washington DC:American Psychiatric Association,1994
16汪向东,王西林,马弘.心理卫生评定量表手册.中国心理卫生杂志,1999
17王纯.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.长沙:中南大学湘雅二医院精神卫生研究所,2009.55-58
18 Carol Ann Houston-Slowik.The effect of reality therapy processes on locus of control and dimensions of self-concept in the school setting of Mexican-American seventh and ninth grade students.Houston,The University of Houston,1982
19 Roddenberry A,Renk K.Locus of control and self-efficacy:potential mediators of stress,illness,and utilization of health services in college students.Child Psychiatry and Human Development,2010,41(4):353-370
20 Gale CR,Batty GD,Deary IJ.Locus of control at age 10years and health outcomes and behaviors at age 30 years:the1970 British Cohort Study.Psychosomatic Medicine,2008,70(4):397-403
21 Glasser W.A new look at school failure and school success.The Phi Delta Kappan,1997,78(8):596-602
22 Mann M,Hosman CMH,Schaalma HP,de Vries NK.Selfesteem in a broad-spectrum approach for mental health promotion.Health Education Research,2004,19(4):357-372
23 Greenberg J,Solomon S,Pyszczynski T,et al.Why do people need self-esteem?Converging evidence that self-esteem serves an anxiety-buffering function.Journal of Personality and Social Psychology,1992,63(6):913-922