强迫障碍的认知行为个案概念化咨询个案报告
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摘要
探讨如何从认知理论和行为理论的视角建构强迫障碍的个案概念化,以及个案概念化对制定咨询策略的重要指导作用。以一例强迫障碍大学生为对象,依据强迫障碍的认知行为概念化模型对其强迫症状发生、发展及维持的机制进行解析,在此基础上制定暴露与反应阻止技术结合认知技术的干预策略,开展为期13周共计17次的咨询实践。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和耶鲁-布朗强迫量表(Y-BOCS)对症状的严重程度进行基线和干预13周后评估。结果显示,来访者焦虑和抑郁的情绪均有明显下降,Y-BOCS得分从咨询前25分降低为咨询后11分,每天花费在强迫检查、强迫清洗上的时间明显减少,社会功能恢复正常。结果提示,强迫障碍的认知理论和行为理论能有效指导个案概念化的建构过程和咨询实践。
To explore how to formulate the case conceptualization of obsessive-compulsive disorder(OCD)in the perspective of cognitive theory and behavioral theory.The current study utilized the cognitive behavioral conceptualization model to account for the development and maintenance of obsessive-compulsive symptoms of a college student with OCD.An intervention strategy combining exposure and reaction prevention(ERP) with cognitive techniques was implemented within a 17-session individual counseling in 13 weeks.Client's anxious,depressive and obsessive-compulsive symptoms were assessed at baseline and after 13-week intervention with the Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS) and Yale-Brown Obsessive Compulsive Scale(Y-BOCS),respectively.Results showed a significant decrease in anxiety and depressive symptoms.The score of Y-BOCS decreased from 25 to 11 after intervention,which indicated normal social functioning.These findings suggested that the cognitive theory and behavioral theory of OCD could effectively guide the process of case conceptualization and the counselling practice.
To explore how to formulate the case conceptualization of obsessive-compulsive disorder(OCD)in the perspective of cognitive theory and behavioral theory.The current study utilized the cognitive behavioral conceptualization model to account for the development and maintenance of obsessive-compulsive symptoms of a college student with OCD.An intervention strategy combining exposure and reaction prevention(ERP) with cognitive techniques was implemented within a 17-session individual counseling in 13 weeks.Client's anxious,depressive and obsessive-compulsive symptoms were assessed at baseline and after 13-week intervention with the Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS) and Yale-Brown Obsessive Compulsive Scale(Y-BOCS),respectively.Results showed a significant decrease in anxiety and depressive symptoms.The score of Y-BOCS decreased from 25 to 11 after intervention,which indicated normal social functioning.These findings suggested that the cognitive theory and behavioral theory of OCD could effectively guide the process of case conceptualization and the counselling practice.
引文
[1]美国精神医学学会.精神障碍诊断与统计手册第五版[M].张道龙,等.译.北京:北京大学出版社,2015:228-231.
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[13]Foa EB,Mclean CP.The efficacy of exposure therapy for anxietyrelated disorders and its underlying mechanisms:the case of OCDand PTSD[J].Annu Rev Clin Psychol,2016,12(1):1-28.
[14]Craske MG,Treanor M,Conway C,et al.Maximizing exposure therapy:an inhibitory learning approach[J].Behav Res Ther,2014,58(1):10-23.
[15]胡艳萍,崔丽霞.案例概念化在临床上的应用[J].心理科学进展,2010,18(2):322-330.
[16]刘兴华,宋斐.一例强迫检查的认知行为治疗案例报告[J].中国心理卫生杂志,2007,21(6):421-423.
[17]李飞,师曾洁,张亚林.爯理智胜过情感爲手册治疗强迫症患者的个案报告[J].中国心理卫生杂志,2015,29(3):178-181.
[18]郑宁.认知行为疗法治疗一例强迫性心理障碍的个案报告[J].中国心理卫生杂志,2005,19(9):633-634.
[19]戴晓阳,张进辅,程灶火.常用心理评估量表手册[M].北京:人民军医出版社,2014.
[20]杨建明,兰光华.耶鲁-布朗强迫症状清单调查强迫症状的初步应用[J].中国健康心理学杂志,2014,22(7):1030-1031.
[21]张一,孟凡强.修改耶鲁-布朗强迫量表的临床信度和效度研究[J].中国心理卫生杂志,1996,10(5):205-207.
[22]罗佳,李占江,韩海英,等.单一认知行为治疗对强迫障碍患者的疗效[J].中国心理卫生杂志,2011,25(12):910-914.
[23]Salkovskis PM.Obsessional-compulsive problems:a cognitive-behavioural analysis[J].Behav Res Ther,1985,23(5):571-583.
[24]Abramowitz JS.Treatment of obsessive thoughts and cognitive rituals using exposure and response prevention:a case study[J].Clin Case Stud,2002,1(1)6-24.
[2]Leahy RL,Holland SJ,McGinn LK.抑郁和焦虑障碍的治疗计划与干预方法(第二版)=Treatment plans and interventions for depression and anxiety disorders(Second Edition)[M].赵丞智,谭宗林,乔慧芬,等,译.北京:中国轻工业出版社,2014.
[3]Brauer L,Lewin AB,Storch EA.A review of psychotherapy for obsessive-compulsive disorder[J].Mind&Brain,the Journal of Psychiatry,2011,2(1):38-44.
[4]汤万杰,杨彦春.强迫障碍的暴露反应/仪式阻断治疗技术(综述)[J].中国心理卫生杂志,2012,26(7):520-524.
[5]Olatunji BO,Davis ML,Powers MB,et al.Cognitive-behavioral therapy for obsessive-compulsive disorder:a meta-analysis of treatment outcome and moderators[J].J Psychiatr Res,2013,47(1):33-41.
[6]Rachman S.A cognitive theory of obsessions:elaborations[J].Behav Res Ther,1998,36(4):385-401.
[7]Salkovskis PM,Harrison J.Abnormal and normal obsessions-a replication[J].Behav Res Ther,1984,22(5):549-52.
[8]Obsessive Compulsive Cognitions Working Group.Cognitive assessment of obsessive-compulsive disorder[J].Behav ResTher,1997,35(7):667-681.
[9]Wilhelm S,Steketee G,Reillyharrington NA,et al.Effectiveness of cognitive therapy for obsessive-compulsive disorder:an open trial[J].J Cognit Psychother,2005,19(2):173-179.
[10]Meyer V.Modification of expectations in cases with obsessional rituals[J].Behav Res Ther,1966,4(4):273-280.
[11]Foa EB,Liebowitz MR,Kozak MJ,et al.Randomized,placebocontrolled trial of exposure and ritual prevention,clomipramine,and their combination in the treatment of obsessive-compulsive disorder[J].Am J Psychiatry,2005,162(1):151-61.
[12]Abramowitz JS,Franklin ME,Foa EB.Empirical status of cognitivebehavioral therapy for obsessive-compulsive disorder:a metaanalytic review[J].Roman J Cognit Behav Psychother,2002,2(2):89-104.
[13]Foa EB,Mclean CP.The efficacy of exposure therapy for anxietyrelated disorders and its underlying mechanisms:the case of OCDand PTSD[J].Annu Rev Clin Psychol,2016,12(1):1-28.
[14]Craske MG,Treanor M,Conway C,et al.Maximizing exposure therapy:an inhibitory learning approach[J].Behav Res Ther,2014,58(1):10-23.
[15]胡艳萍,崔丽霞.案例概念化在临床上的应用[J].心理科学进展,2010,18(2):322-330.
[16]刘兴华,宋斐.一例强迫检查的认知行为治疗案例报告[J].中国心理卫生杂志,2007,21(6):421-423.
[17]李飞,师曾洁,张亚林.爯理智胜过情感爲手册治疗强迫症患者的个案报告[J].中国心理卫生杂志,2015,29(3):178-181.
[18]郑宁.认知行为疗法治疗一例强迫性心理障碍的个案报告[J].中国心理卫生杂志,2005,19(9):633-634.
[19]戴晓阳,张进辅,程灶火.常用心理评估量表手册[M].北京:人民军医出版社,2014.
[20]杨建明,兰光华.耶鲁-布朗强迫症状清单调查强迫症状的初步应用[J].中国健康心理学杂志,2014,22(7):1030-1031.
[21]张一,孟凡强.修改耶鲁-布朗强迫量表的临床信度和效度研究[J].中国心理卫生杂志,1996,10(5):205-207.
[22]罗佳,李占江,韩海英,等.单一认知行为治疗对强迫障碍患者的疗效[J].中国心理卫生杂志,2011,25(12):910-914.
[23]Salkovskis PM.Obsessional-compulsive problems:a cognitive-behavioural analysis[J].Behav Res Ther,1985,23(5):571-583.
[24]Abramowitz JS.Treatment of obsessive thoughts and cognitive rituals using exposure and response prevention:a case study[J].Clin Case Stud,2002,1(1)6-24.