治疗一种“无法治愈”心理疾病的新希望 简版
www.psychspace.com心理学空间网

FT0@a|Av*sg0治疗一种“无法治愈”心理疾病的新希望。

2MUhFR bJ0心理学空间K7F8Kn*K0N E

一种革命性的治疗方案让边缘型人格障碍患者获得痊愈。心理学空间$n%v)g]d3Eqj

心理学空间eNG[4Q@N*g\

一项大规模的研究结果第一次显示,边缘型人格障碍患者的临床症状全部被治愈的比例会很高。美国医学会发表在近一期《普通精神病学文献》的文章认为,对照研究表明新的治疗方法——图式疗法——其效率超过以往广泛应用的心理动力疗法,即移情焦点治疗(TFP)的两倍。研究发现图式疗法更省钱,患者终止治疗的比例更低。近年来人们才认为边缘型人格障碍(BPD)是无法治愈的,基本没有科学证据来支持更长期的治疗。

I^6lh9L1{I,Vv0心理学空间*Y.x3`R,r

这项研究表明图式疗法使大约50%的患者获得痊愈,而且2/3患者的病情得到明显改善。图式疗法的成功主要因为它持续时间长、强度大(在三年中,每个星期有两次和患者对话)。治疗结果强有力的反驳了原先流行的观点,即BPD无法得到治愈,更长期的心理疗法是无效的。心理学空间-r H,J:R Y ha$eH

心理学空间YG3^#Oh;K^'C A RNrF

根据美国国立精神卫生研究所的资料,边缘型人格障碍在总人口出现的概率为1%到2.5%——约580万到870万美国人患此病,大多数的患者为青年女性。此类患者在生活中表现的相当有攻击性:他们具有典型的冲动性、情绪不稳定、被拒绝时相当敏感、经常突然生气、每天情绪极度痛苦。他们经常会自残,而且反复会有自杀的念头。他们无法自我认知、对压力忍耐力弱、害怕被人抛弃。这些问题也使得不仅是患者,和患者一起住的人都很苦恼。很多边缘型人格障碍患者要么不能工作,要么不能按照应有的智力正常生活。于是,此病抬高了医疗和社会成本,因为超过1/5入院的精神病患者都是患此病。

+o/q wCF(Rv0

O3~S&u8Jj!Y0直到最近,心理疗法只对BPD的一些症状起作用。最有效的可行方法,如辨证行为治疗,减轻了患者很多自毁行为症状。但这些方法没能减轻很多核心症状,特别是那些关系到更深层次性格改变的症状。心理学空间J _j"O/D

z7Nh|fTR P0心理学家Jeffrey Young在纽约工作,是医学博士(在哥伦比亚大学的精神科任职)。他在二十世纪八十年代中期开始发展图式聚焦疗法。受其成功的激励,他在二十世纪九十年代中期于曼哈顿建立了第一个图式疗法研究所。此疗法被很多美国、欧洲和亚洲的临床医生所接受,随之引起了荷兰研究人员的注意,他们之前对边缘型人格障碍做了大范围的治疗性研究。图式疗法的逻辑严密,使得它适合对照研究。心理学空间;Ud$g'yV @ P

心理学空间kF6f(g)l

荷兰的研究人员包括Josephine Giesen-Bloo医生和Arnoud Arntz医生(项目的领导人)。在边缘型人格障碍治疗的研究中,他们将图式疗法(也称为图式焦点疗法或者SFT)和移情焦点治疗(TFP)相比较。86名患者来自荷兰的四个精神健康研究所。在此研究中,患者接受共三年、每周两次对话的SFT或者TFP治疗。三年后,接受SFT治疗的患者有45%痊愈,接受TFP治疗的患者有24%痊愈。第四年后,接受SFT治疗的患者有52%痊愈,接受TFP治疗的患者有29%痊愈。在SFT组,70%的患者得到“明显及适当的临床改善”。而且,在SFT组,中途退出研究的人数只有27%,与之相比,TFP组有50%退出。这表明图式疗法让患者更为忠诚。

U R\tyvp0心理学空间d9N-m9ssy9U/S8\$d ?

在第一年后,患者开始的自我感觉和行为都明显改善,SFT组患者改善得更快。在接下来的几年,症状持续得到改善。因此,研究认为总结说,这两种治疗都有积极的疗效,而图式疗法更为有效。心理学空间Bm4C/u?3~2P|!S

0B\.`$r Y'S0心理学空间2x"l9d-K_b

8TuG5X][%rp#d0图式疗法是一种综合疗法,它建立在行为认知疗法的原理基础上。然后才扩展并包括来自其他心理疗法的技术和观念。通过运用认知疗法、行为疗法和情绪聚焦疗法,图式治疗学家帮助患者改变他们的封闭的、自我挫败的生活模式或者心理图式。治疗集中在处理与治疗医生的关系、除治疗外的日常生活及此病常有的童年心理受创经历。Young医生相信图式疗法获得更的成功的原因有一部分是它运用了“养育方案”,这是其他治疗BPD疗法所没有的。

Nu6Z5?l#bm0心理学空间)D Xb-X {m8q

图式疗法和移情焦点治疗都把焦点放在更深层次的性格改变上。与之相对的是,最近的其他疗法在减少此病的特定行为症状上有局限,如自残行为。Young说:“BPD的其他疗法也能提高患者的应对技能并明显减少自残行为,如辨证行为治疗。而接受图式疗法后,患者还能从原先充满混乱、痛苦的生活中解脱出来并从深层次改变性格。心理学空间*OV m t'D#dT\C

心理学空间"H.[.^!G{:K3\|r\u0a

尽管疗程超过三年并且患者需要接受很多次的对话治疗,图式疗法的性价还是比很高。在研究中,作者做的一项经济学分析(没有发表在《普通精神病学文献》)表明,如患者都接受图式疗法,则每年荷兰政府可以从每个患者身上获得4500的净收入(约等于5700美元),尽管这是一种成本密集型治疗方案。事实证明,在数年的疗程结束后,节约的钱会更多。心理学空间L2v S3AK

WuY"Dot9X0图式疗法治疗学家和研究人员都希望图式疗法,这种治疗边缘型人格障碍——过去这么多年都被认为难处理的疾病——的有效疗法得到批准。这将导致更多的研究并鼓励更多的临床医生来学习图式疗法。他们也希望这项研究会让健康保险公司相信,投资这种有效的长期心理治疗是有利可图的,因为此疗法用于治疗这种痛苦和昂贵的疾病。心理学空间Gq\p|q0y*DA*cd FH

vb%nLdT6ix0New hope for an 'untreatable' mental illness

ryX7\r"H1y0

TXt)YP1fje0Innovative therapy fosters full recovery for patients with borderline personality disorder

0ZU:q0L8w^%i0

e:dB_ tU~0For the first time, a major outcome study has shown that a high percentage of patients with Borderline Personality Disorder can achieve full recovery across the complete range of symptoms. The controlled study, appearing in a recent issue of the Archives of General Psychiatry published by the American Medical Association, shows that a new approach -- Schema Therapy -- is more than twice as effective as a widely practiced psychodynamic approach, Transference Focused Psychotherapy (TFP). Schema Therapy was also found to be less costly and to have a much lower drop out rate. Borderline Personality Disorder (BPD) has until recent years been considered untreatable, with little scientific justification for longer-term therapy.心理学空间Ade(u7s,vcu

B E6O2x,T*^}l:K8{I&Y0This study demonstrates that schema therapy leads to complete recovery in about 50% of the patients, and to significant improvement in two-thirds. The success of the therapy is strongly related to its duration and intensity (two sessions a week for 3 years). The results clearly contradict the prevailing opinion that BPD cannot be fully cured, and that longer-term psychotherapy is ineffective. 心理学空间CQ9?m2\{eY

rW3~%Y!\ o0According to the National Institute of Mental Health, Borderline Personality Disorder is found in about 1 to 2.5 percent of the general population--about 5.8 to 8.7 million Americans, most of whom are young women. Patients with the disorder live life on the edge: they're typically impulsive, unstable, exquisitely sensitive to rejection, have regular outbursts of anger, and live daily with extreme emotional pain. They often self-mutilate and make repeated suicide attempts. Identity problems, low stress tolerance, and fears of abandonment also make the disorder difficult for patients and for those who live with them. Many with BPD either cannot work or do not function at levels that could be expected in light of their intellectual capacities. As a result, the disorder carries high medical and societal costs, accounting for more than one in every five inpatient psychiatric admissions.

j"Z U Zfa,O9^0

~h `TF`,F%BP l0Until recently, psychotherapy offered help for only some of the symptoms of BPD. The best available alternatives, such as Dialectical Behavioral Therapy, relieve many of the self-destructive behavioral symptoms of the disorder but have not been able to reduce many of the other core symptoms, especially those related to deeper personality change.心理学空间rW*nn-Aw'q"v9[`

vr'Qi#q0New York-based psychologist Jeffrey Young, Ph.D. (on the faculty in the Dept. of Psychiatry at Columbia University) began to develop Schema Focused Therapy in the mid-1980s. Encouraged by its success, he established the first Schema Therapy Institute in the mid-1990s in Manhattan. Adopted by many clinicians in the United States, Europe, and Asia, the therapy came to the attention of researchers in the Netherlands who were developing a large-scale study of treatments for Borderline Personality Disorder. The clearly articulated approach of Schema Therapy lent itself well to a controlled outcome study.

;n"kz|F"VR0

9G-k'Y8N Z:C&YL0In this study, Dutch investigators, including Dr. Josephine Giesen-Bloo and Dr. Arnoud Arntz (the project leader), compared Schema Therapy (also known as Schema Focused Therapy or SFT) with Transference Focused Psychotherapy (TFP) in the treatment of Borderline Personality Disorder. 86 patients were recruited from 4 mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for 3 years. After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP. One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving "clinically significant and relevant improvement". Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP, indicating that Schema Therapy instilled a greater sense of allegiance among patients.

,U(n k/v}-Lb0

y ^(|!]T8p`m0Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group. There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with Schema Therapy clearly more successful.心理学空间v[t.g7v6Xgk

心理学空间 J6I1e0U#s_G,T:n

Schema Therapy is an integrative approach, founded on the principles of cognitive-behavioral therapy, then expanded to include techniques and concepts from other psychotherapies. Schema Therapy is an integrative approach, founded on the principles of cognitive-behavioral therapy, then expanded to include techniques and concepts from other psychotherapies. Schema therapists help patients to change their entrenched, self-defeating life patterns ?or schemas -- using cognitive, behavioral, and emotion-focused techniques. The treatment focuses on the relationship with the therapist, daily life outside of therapy, and the traumatic childhood experiences that are common in this disorder. Dr. Young believes that Schema Therapy's greater effectiveness arises in part from its use of "limited reparenting," which is not part of other approaches to BPD.心理学空间\X7J4xj}m

+nCSj\6^{ M$O3H0Both Schema Therapy and Transference Focused Psychotherapy focus on deeper personality change, in comparison to other recent treatments that have been limited to the reduction of specific behavioral symptoms of the disorder, such as self-mutilation. According to Dr. Young: "Other treatments for BPD, such as Dialectical Behavior Therapy, have also led to more effective coping skills and a significant reduction in self-harm. With Schema Therapy, patients are, in addition, breaking free of lives of chaos and misery and making deeper personality changes."心理学空间 q(Q"zE4r3Wv

#G W0@e&P4j6^_&~0Although the treatment involves many sessions over three years, Schema Therapy is nevertheless cost-effective. An economic analysis conducted by the authors of the study (not included in the Archives article) indicated that, for each year Schema Therapy patients were in the study, Dutch society benefited from a net gain of 4,500 Euros per patient (the equivalent of about 5,700 US dollars), despite the cost-intensive treatment. The savings over the course of several years after the completion of treatment could actually prove to be higher.心理学空间R8Vq]1T$qT

心理学空间;Az Y y:|'m

Schema therapists and researchers are hoping that this validation of the effectiveness of Schema Therapy for patients with Borderline Personality Disorder -- that for so many years has been considered intractable--will lead to more research studies and will encourage more clinicians to learn Schema Therapy. They also hope that this study will convince healthcare insurers to reimburse the costs of effective longer-term psychotherapy for this painful and costly illness.心理学空间6vs)jE'Zj3Q)c kC

心理学空间%K:G^f&n u l*N

http://www.eurekalert.org/pub_releases/2006-10/ppmr-nhf101006.php 2006-10-10心理学空间3O[ |e/h-`6\CX

1Bq(|JXB0 

Y8d\J/L#ug0www.psychspace.com心理学空间网
«Role playing and role reversal 角色扮演与角色转换技术 图式治疗
《图式治疗》
分离保护者模式简介The detached protector»
Michael Darden 作者:Michael Darden / 3952次阅读
时间:2006年11月01日
来源: EurekAlert
路径 > 心理咨询 > 认知行为疗法 > 图式治疗
图式治疗文章更新