CBTとIPTの比較試験
Social phobia に対しての治療効果
The purpose ofthis study was to test cognitive and
interpersonal models for improving social phobia. Eighty
patients with social phobia were randomized to 10-week
residential cognitive (RCT) or residential interpersonal
psychotherapy (RIPT). They completed process measures
every Thursday and a sub-outcome measure every Monday.
The ratings were analyzed with mixed models. Weekly
changes in the process variables derived from the cognitive
model(self-focus, estimated probability and estimated cost
of negative social events, safety behaviors) predicted
subsequent weekly changes in social anxiety. Changes in
the interpersonal variable perceived acceptance by others
also predicted subsequent changes in sodal anxiety. On the
other hand, changes in social anxiety predicted changes in
the four cognitive variables. There were no interactive
effects of process with treatment. The cognitive variables
decreased during treatmentto a similar degree in both
treatments. The results indicate that,to reduce social
anxiety,therapy should target self-focus, estimated prob-
ability and cost of feared social events, safety behaviors, and
perceived acceptance by others. The process of improvement
may involve positive cycles in that a reduction of social
anxiety,in turn, appeared to impact self-focus, probability,
cost, and safety behaviors.
概説部分が参考になりました
SOCIAL PHOBIA is a prevalent, severe,impairing, and
chronic disorderfor which effective treatment
methods are clearly needed. Based on an empirical
analysis of the cognitive processes in social phobia,
Clark and Wells (1995) developed a new cognitive
model.Individual cognitive therapy (CT) derived
from this model has been associated with large effect
sizes and superior to a combination of fluoxetine and
self-exposure (Clark et al., 2003),to a combination
of exposure and applied relaxation (Clark et al.,
2006),to group CT (Mortberg, Clark, Sundin, &
Aberg Wistedt, 2007; Stangier, Heidenreich, Peitz,
Lauterbach, & Clark, 2003), and to routine
psychiatric treatment involving medication and
emotional support(Mortberg et al., 2007). On the
other hand, symptoms of social phobia may be
viewed as a part of and/or as maintained by more
general interpersonal difficulties. Thus,interpersonal
psychotherapy (IPT) may also be considered a
plausible treatment for social phobia (Lipsitz,
Markowitz, & Cherry,1997).IPT has proved to
be efficacious for a number of disorders (Weissman,
Markowitz, & Klerman, 2000). A clinical case series
indicated that patients with social phobia improved
during individual IPT (Lipsitz, Markowitz, Cherry,
& Fyer,1999), but superiority to a control condition
has yet to be demonstrated. Although both these
therapies may prove to be efficacious, efficacy in
itself does not prove the validity of a therapy model.
An analysis of in-therapy change processes may both
serve to evaluate the adequacy of the applied model
and to suggest improvement in the therapies.
ーーーーーーーーーーーーー
Patients in both conditions showed robust improvements
from pre-to post treatment, and continued their
improvements in the 1-year follow-up period. There
were no differences in outcome between residential
CT (RCT)
and residentialIPT (RIPT). RCTand.RIPT
were rated as equally credible.
という大変穏当な結果である
どっちも優れている
念の為にCBTとIPTの概説を見てみると
CBTは
The cognitive model posits that social anxiety and
avoidance are essentially maintained by:(a) beliefs
characterized both by overestimation ofthe prob-
ability of acting in an inept and unacceptable way in
social situations and by overestimation of the cost
(negative consequences) of these events;(b) an
increase in self-focused attention and monitoring,
with a corresponding reduction in the observation
of other people and their responses; and (c)
extensive use of safety behaviors that are intended
to prevent feared catastrophes but have the con-
sequence of maintaining negative beliefs,increasing
feared symptoms, and making patients come across
to others in ways that are likely to elicit less friendly
responses.
簡単すぎる感じもするが
たぶんいい要約なのだろう
IPTは
The interpersonal model posits that social phobia
is characterized by social role insecurity. People with
social phobia feel unsure about, and have difficulties
in, socializing with others, disclosing personal
matters, asserting their interests, and experiencing
positive aspects of social interactions and perfor-
mance, despite showing the ability to manage these
situations when they feel safe (Lipsitz et al.,1997).
As a consequence of insecurity,they develop a
variety of self-protective strategies. They refrain
from expressing wishes and feelings, hide anxiety,
try to exhibit polished social performance, and
withdraw as soon as possible. Thus, others are
kept unaware of the person’s wishes and feelings and
cannot respond to the actual self. Furthermore,the
use of self-protective behaviors may make the person
with social phobia appear aloof and uninterested in
others. This may have the consequence that other
people feel rejected or ignored and subsequently
withdraw.In this way,they engage in self-perpetuat-
ing interactional cycles,in which they unwittingly
produce the very response they fear –a lack of
interest and warmth and even negative evaluation
from others (Alden, 2001). Thus,the self-protective
behaviors maintain and consolidate social role
insecurity and social anxiety.In turn, self-observa-
tion of their fear, avoidance, and offailing to
perform adaptive social skills strengthens their social
anxiety and role insecurity (Lipsitz et al.,1997).
ここで
People with
social phobia feel unsure about, and have difficulties
in, socializing with others, disclosing personal
matters, asserting their interests, and experiencing
positive aspects of social interactions and perfor-
mance, despite showing the ability to manage these
situations when they feel safe (Lipsitz et al.,1997).
というような表現をするとやはり紛らわしくて不十分ではないかと思う。
たとえばシゾフレニーの場合でもfeel safe ならばsocial 機能をうまく発揮できるだろうし
socializing with others の機能で考えるのはどうかと思うが
全体を読んでみればそのような揚げ足取りもしなくていいのだろうけれど
さらに後半の部分は最近では広汎性発達障害の類型にも紛らわしいような表現になっていると思うが
悪循環があることに注目しているので
むしろ発達障害の場合にもこのような悪循環を想定しても当てはまるのかもしれないと思う
余計焦るというわけだ
しかしこれがIPT的なモデルの要約かといえば疑問だ
social role insecurity
という言葉は対人関係療法的なのか
