2023/09/01

辯證行為治療應用於青少年的實證療效研究

文/馬偕紀念醫院精神醫學部暨自殺防治中心 劉珣瑛教授
辯證行為治療(Dialectical behavior therapy, DBT)最初是為了治療罹患邊緣性人格疾患的重複自殺自傷成年人所發展的。在累積治療成年人的成功經驗後,DBT 發展了青少年版本(DBT for adolescents, DBT-A),調整一些內容以適合青少年使用,治療時間從一年縮短至24週(Rathus, 2015)。

完整的 DBT-A 治療同樣包括每周一次個別治療、團體治療、治療者團隊會議及24小時電話輔導,另外加入家庭治療。研究發現 DBT 所教授的技能包括基本社交和情感生活能力,非常適用於相似的臨床症狀、情緒行為調節困難、或自殺自傷的青少年(Mehlum L, et al., 2014; Flynn D, et al., 2018; Glenn CR, et al., 2019)。

在針對自傷自殺行為的高危兒童青少年,DBT 是少數具有實證療效的治療方法(Perepletchikova F, et al., 2011; McCauley E, et al. 2018; Kothgassner OD, et al., 2021; Witt KG, et al., 2021),研究發現 DBT 不只可以降低青少年自殺自傷行為想法與邊緣性人格症狀(Chugani CD, 2013),DBT 的情緒調節對改善青少年或大學生的憤怒情緒(Haktanir A, et al., 2022)、憂鬱症狀(Panepinto AR, et al., 2015; Turan B et al, 2022)、焦慮症狀(Webb CA, et al. 2016)、物質濫用、外化行為等都有顯著療效。 Poon等人(2022)以完整 DBT-A 治療男同性戀、女同性戀、雙性戀或質疑自己性向的青少年,都能顯著的改善他們的情緒調節、憂鬱、邊緣症狀和應對策略能力等(Poon et al. 2022; Tilley JL, et al. 2022)。此外,DBT 也可以幫助罹患注意力缺失過動症的青少年顯著改善其過動/衝動、行為問題和情緒失調症狀(Meyer J, et al. 2022)。在Goldstein 等人的研究中(2015)證實 DBT 可以作為罹患雙極性情感疾患的青少年藥物療法的輔助治療,尤其可改善鬱期時的憂鬱症狀和自殺意念,且可以加強青少年對治療的承諾。其他 DBT 在青少年的實證研究還包括治療青少年飲食疾患(Kamody RC et al., 2019; Reilly EE, et al., 2020; Vogel EN, 2021)、對立反抗疾患(Nelson-Gray RO et al., 2006)、侵擾性情緒失調疾患(Perepletchikova F, et al. 2017)等都有顯著療效的研究報告。

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