倪照军;栗雪琪;黄薛冰;

• 1:北京大学第六医院北京大学精神卫生研究所国家卫生健康委员会精神卫生学重点实验室(北京大学)国家精神心理疾病临床医学研究中心(北京大学第六医院)

摘要(Abstract)：

目的:验证团体正念认知治疗(MBCT)与团体认知行为治疗(CBT)对广泛性焦虑障碍患者的焦虑症状和注意维持功能等效性。方法:选取符合DSM-IV广泛性焦虑障碍诊断的患者138例，将其随机分配进入团体MBCT+常规治疗组和团体CBT+常规治疗组，两组在进行常规的门诊药物治疗外，分别给予8周的团体MBCT和团体CBT。采用汉密顿焦虑量表(HAMA)和持续操作测验-相同配对版(CPT-IP)评估患者在基线、治疗8周后的焦虑症状与注意维持功能。结果:8周治疗结束时，两组的HAMA评分均较基线降低(均P<0.001),CPT得分均较基线提高(均P<0.05);两组间的HAMA临床有效率(87.50%vs.81.48%)、临床治愈率(71.43%vs.59.26%)、HAMA减分情况、CPT得分差异均无统计学意义(均P>0.05)。结论:团体正念认知治疗与团体认知行为治疗均可以有效缓解广泛性焦虑障碍患者的焦虑症状、改善注意维持功能，且两种治疗方法的效果相当。

关键词(KeyWords)： 正念认知治疗;认知行为治疗;广泛性焦虑障碍;注意力

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项基金(No.2018-2-4114)

作者(Authors): 倪照军;栗雪琪;黄薛冰;

参考文献(References)：

• [1] Huang YQ,Wang Y,Wang H,et al.Prevalence of mental disorders in China:a cross-sectional epidemiological study[J].Lancet Psychiatry,2019,6(3):211-224.
• [2] Pelletier L,O' Donnell S,Mcrae L,et al.The burden of generalized anxiety disorder in Canada[J].Health Promot Chronic Dis Prev Can,2017,37(2):54-62.
• [3] Porensky EK,Dew MA,Karp JF,et al.The burden of late-life generalized anxiety disorder:effects on disability,health-related quality of life,and healthcare utilization[J].Am J Geriatr Psychiatry,2009,17(6):473-482.
• [4] Langarita-Llorente R,Gracia-Garcia P.Neuropsychology of generalized anxiety disorders:a systematic review[J].Rev Neurol,2019,69(2):59-67.
• [5] American Psychiatric Association.Diagnostic and statistical manual of mental disorders(DSM-V)[M].Arlington,VA:American Psychiatric Publishing,2013.
• [6] Katzman MA,Bleau P,Blier P,et al.Canadian clinical practice guidelines for the management of anxiety,posttraumatic stress and obsessive-compulsive disorders[J].BMC Psychiatry,2014,14 (Suppl 1):S1.doi:10.1186/1471-244X-14-S1-S1.
• [7] Battagliese G,Caccetta M,Luppino OI,et al.Cognitive-behavioral therapy for externalizing disorders:a meta-analysis of treatment effectiveness[J].Behav Res Ther,2015,75:60-71.doi:10.1016/j.brat.2015.10.008.
• [8] Bulzacka E,Lavault S,Pelissolo A,et al.[Mindful neuropsychology:mindfulness-based cognitive remediation][J].Encephale,2018,44(1):75-82.
• [9] 李歆.60例广泛性焦虑障碍住院患者正念团体治疗的随机对照研究[D].苏州：苏州大学，2015.
• [10]陈淑燕，谢稚鹃，黄薛冰，等.集体认知行为治疗对广泛性焦虑障碍疗效的随机对照研究[J].中国心理卫生杂志，2017,31(3):177-182.
• [11]Hamilton M.The assessment of anxiety states by rating[J].Br J Med Psychol,1959,32(1):50-55.
• [12]李凌江，马辛.中国抑郁障碍防治指南(第二版)[M].北京：中医学会电子音像出版社，2015.
• [13]田国强，甘建光.连续操作测验检测持续性注意功能[J].中国临床神经科学，2009,17(6):653-656.
• [14]Yatham LN,Torres IJ,Malhi GS,et al.The International Society for Bipolar Disorders-Battery for Assessment of Neurocognition (ISBD-BANC)[J].Bipolar Disord,2010,12(4):351-363.
• [15]于欣.MCCB中国常模手册[M].北京：北京大学医学出版社，2014.
• [16]Segal ZV,Williams M,John T.Mindfulness-based cognitive therapy for depression[M].New York:Guilford Press,2012.
• [17]Xie ZJ,Han N,Law S,et al.The efficacy of group cognitive-behavioural therapy plus duloxetine for generalised anxiety disorder versus duloxetine alone[J].Acta Neuropsychiatr,2019,31(6):316-324.
• [18]Zhao XR,Chen ZF,Kang CY,et al.Mindfulness-based cognitive therapy is associated with distinct resting-state neural patterns in patients with generalized anxiety disorder[J].Asia Pac Psychiatry,2019,11(4):e12368.
• [19]Hoge EA,Bui E,Marques L,et al.Randomized controlled trial of mindfulness meditation for generalized anxiety disorder:effects on anxiety and stress reactivity[J].J Clin Psychiatry,2013,74(8):786-792.
• [20]Mantella RC,Butters MA,Amico JA,et al.Salivary cortisol is associated with diagnosis and severity of late-life generalized anxiety disorder[J].Psychoneuroendocrinology,2008,33(6):773-781.
• [21]Hoge EA,Bui E,Palitz SA,et al.The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder[J].Psychiatry Res,2018,262:328-332.doi:10.1016/j.psychres.2017.01.006.
• [22]Koerner N,Dugas MJ.Cognitive-behavioral treatment for generalized anxiety disorder:current status and future directions[J].J Cognit Psychother,2005,19(1):61-81.
• [23]Dugas MJ,Gagnon F,Ladouceur R,et al.Generalized anxiety disorder:a preliminary test of a conceptual model[J].Behav Res Ther,1998,36(2):215-226.
• [24]Borza L.Cognitive-behavioral therapy for generalized anxiety[J].Dialogues Clin Neurosci,2017,19(2):203-208.
• [25]Fonzo GA,Ramsawh HJ,Flagan TM,et al.Cognitive-behavioral therapy for generalized anxiety disorder is associated with attenuation of limbic activation to threat-related facial emotions[J].J Affect Disord,2014,169:76-85.doi:10.1016/j.jad.2014.07.031.
• [26]Sipe WE,Eisendrath SJ.Mindfulness-based cognitive therapy:theory and practice[J].Can J Psychiatry,2012,57(2):63-69.
• [27]Sciberras E,Efron D,Patel P,et al.Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes?Protocol for a randomized controlled trial[J].BMC Psychiatry,2019,19(1):359.
• [28]Gill LN,Renault R,Campbell E,et al.Mindfulness induction and cognition:a systematic review and meta-analysis[J].Conscious Cogn,2020,84:102991.doi:10.1016/j.concog.2020.102991.
• [29]Kopp MS.Psychophysiological characteristics of anxiety patients and controls[J].Psychother Psychosom,1989,52(1-3):74-79.
• [30]Pan MR,Huang F,Zhao MJ,et al.A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with attention-deficit/hyperactivity disorder(ADHD)[J].Psychiatry Res,2019,279:23-33.doi:10.1016/j.psychres.2019.06.040.
• [31]Vago DR,Silbersweig DA.Self-awareness,self-regulation,and self-transcendence (S-ART):a framework for understanding the neurobiological mechanisms of mindfulness[J].Front Hum Neurosci,2012,6:296.doi:10.3389/fnhum.2012.00296.