社交焦虑障碍认知行为治疗前后静息态局部一致性研究

发布时间：2018-04-09 21:26

本文选题：社交焦虑障碍　切入点：认知行为治疗　出处：《四川大学学报(医学版)》2016年06期

【摘要】：目的检测社交焦虑障碍(social anxiety disorder,SAD)患者认知行为治疗(cognitive behavior treatment,CBT)前后静息态大脑自发活动变化,探讨SAD形成、治疗和恢复的神经机制。方法对15例SAD患者进行8周的团体CBT治疗,并在治疗前后对患者进行静息态功能磁共振扫描。纳入健康对照18例并进行基线水平的功能磁共振扫描。采用局部一致性(regional homogeneity,ReHo)分析并进行患者与对照的组间、患者治疗前后组内比较。在第一次MRI扫描之前对所有被试采用Liebowitz社交焦虑量表(LSAS)、汉密尔顿焦虑(HAMA)量表、汉密尔顿抑郁(HAMD)量表进行评估。患者组在心理治疗结束后的1周内进行第二次MRI扫描,并再次评估上述量表得分。所有被试均采用临床量表评估症状。结果所有研究对象均为右利手。患者组男性11例,女性4例,平均年龄(27.07±8.11)岁,对照组男性13例,女性5例,平均年龄(26.28±2.42)岁。患者组与对照组间性别、年龄差异无统计学意义。量表LSAS、HAMA、HAMD在患者组和对照组之间差异有统计学意义(P0.01),在8周的CBT之后患者组的临床量表得分较治疗前降低。和健康对照组相比,SAD患者治疗前右小脑后叶ReHo增高〔P0.05,多重比较校正(GRF校正)〕,治疗后各脑区ReHo差异无统计学意义;SAD患者治疗前后自身比较显示左壳核、右尾状核ReHo增高(P0.05,GRF校正)。治疗前后患者右小脑后叶平均ReHo的改变与Liebowitz社交焦虑量表的恐惧分量的减分(ΔLSAS-fear)改变呈正相关(r=0.62,P=0.015)。结论心理治疗可以通过恢复小脑异常的自发活动来达到减轻SAD临床症状的目的。小脑可能是认知行为治疗对于SAD治疗中调控疗效的一个潜在的生物学标记,这对更深入和全面探索SAD的病理生理机制提供了依据。
[Abstract]:Objective to investigate the changes of spontaneous brain activity before and after cognitive behavior treatment in patients with social anxiety disorder (SAD), and to explore the neural mechanism of SAD formation, treatment and recovery.Methods Fifteen patients with SAD were treated with group CBT for 8 weeks. Resting functional magnetic resonance imaging was performed before and after treatment.Functional magnetic resonance imaging (fMRI) at baseline level was performed in 18 healthy controls.Regional homogenicity was used to analyze and compare the patients with the control group before and after treatment.Before the first MRI scan, all subjects were evaluated with Liebowitz Social anxiety scale (Liebowitz), Hamilton anxiety scale (Hama) and Hamilton Depression scale (Hamd).The second MRI scan was performed within 1 week after psychotherapy and the score of the above scale was evaluated again.All subjects were assessed with a clinical scale.Results all subjects were right-handed.There were 11 males and 4 females in the patient group, with an average age of 27.07 卤8.11 years, while 13 males and 5 females in the control group, with an average age of 26.28 卤2.42 years.There was no significant difference in sex and age between the patient group and the control group.There was significant difference between the two groups (P 0.01). After 8 weeks of CBT, the scores of the clinical scale in the patients group were lower than those before treatment.Compared with the healthy control group, the ReHo in the right cerebellum posterior lobe was increased by P0.05, and the multiple comparison correction was performed. There was no significant difference in ReHo in all brain regions before and after treatment. The left putamen nucleus was found in the patients before and after treatment.The ReHo of the right caudate nucleus was increased (P 0.05).There was a positive correlation between the change of mean ReHo in the right cerebellar posterior lobe before and after treatment and the decrease of the fear component of Liebowitz social anxiety scale (螖 LSAS-fear).Conclusion Psychotherapy can relieve the clinical symptoms of SAD by restoring abnormal spontaneous activity of cerebellum.The cerebellum may be a potential biological marker for the regulation of therapeutic effects of cognitive behavioral therapy on SAD, which provides a basis for further and comprehensive exploration of the pathophysiological mechanism of SAD.
【作者单位】：四川大学华西医院心理卫生中心;
【基金】：国家自然科学基金(No.81371484)资助
【分类号】：R749.72

【相似文献】