Psychosomatic Effects And Neurobiological Mechanisms Of Attribution Retraining Group Therapy For Major Depression Disorder, Anxiety Disorder And Obsessive-Compulsive Disorder

PartⅠ:Comparison of symptomatology,physiopsychosocial function of major depression disorder,anxiety disorder and obsessive-compulsive disorderObjectiveTo compare symptomatology and physiopsychosocial function difference of outpatients with major depression disorder(MDD),anxiety disorder(AD) and obsessive-compulsive disorder(OCD).MethodsA cross-sectional study design was used to compare symptomatology and physiopsychosocial function of MDD(n=45),AD (n=45),and OCD(n=39) outpatients.Plasma substances were detected including 5-hydroxytryptamine(5-HT),norepinephrine(NE),cortisol, adrenocorticotropic hormone(ACTH),and brain-derived neurotrophic factor(BDNF).Psychosocial function were assessed with Hamilton depression scale(HAMD),Hamilton anxiety scale(HAMA),self-rating Depression Scale(SDS),self-rating anxiety scale(SAS),attributional style questionnaire(ASQ),Connor-Davidson resilience scale(CD-RISC), the self-esteem scale(SES),index of well-being(IWB),Eysenck personality questionnaire short scale for Chinese(EPQ-RSC),and social disability screening schedule(SDSS).Results1.The total scores of HAMD,SDS,SAS in MDD group were higher than AD group and OCD group.The total scores of HAMA in MDD group and AD group were higher than OCD group.The 21th item obsessive compulsive scores of HAMD in OCD group were higher than MDD group and AD group.2.For HAMD subscales,the MDD group got higher scores on retardation,sleep disturbance and hopelessness subscales than AD group and OCD group.The anxiety subscale scores in MDD group and AD group were higher than OCD group.The cognition disturbance subscale scores in MDD group and OCD group were higher than AD group.OCD group got higher scores on hopelessness subscale than AD group.There were no significant difference on weigh and diurnal variation subscales among the three groups.3.Seven new subscales were divided by factor analysis,including: (1) anxious emotions,(2) depressed symptoms,(3) somatic nervous symptoms,(4) internal organ symptoms,(5) genito-urinary symptoms,(6) autonomic symptoms,and(7) behavior at interview.The depressed symptoms subscale scored higher in MDD group than AD group and OCD group.The somatic nervous symptoms and internal organ symptoms subscales scores were higher in MDD group and AD group than OCD group.There were no significant differences on anxious emotions,genito-urinary symptoms,autonomic symptoms and behavior at interview subscales among the three groups.4.No evidence was found of any significant difference in the levels of plasma 5-HT,NE,ACTH,cortisol,and BDNF among the three groups.5.MDD group got lower scores on extraversion,neuroticism than OCD group and subjective well-being than AD group.The resilience scores were higher in AD group than MDD group and OCD group.There were no significant differences on attributional styles,hopelessness, self-esteem and psychoticism among the three groups.6.MDD,AD and OCD groups showed similar social function.Conclusions1.AD and OCD outpatients share similar depressed symptomatology and MDD outpatients are more serious in that.AD and MDD outpatients share similar anxious and obsessive compulsive symptomatology and OCD outpatients are serious in obsessive compulsive symptomatology and lighter in anxious symptomatology.Anxious emotions,genito-urinary symptoms,autonomic symptoms,and behavior at interview are the non-specific symptoms of MDD,AD and OCD.AD symptomatology=the non-specific symptoms+some other anxious symptoms(somatic nervous symptoms and internal organ symptoms).OCD symptomatology=the non-specific symptoms+some other depressed symptoms(cognition disturbance and hopelessness)+the specific OCD symptom(obsessive compulsive symptoms).MDD symptomatology=AD symptomatology+OCD symptomatology+the specific MDD symptoms(retardation and sleep disturbance)-the specific OCD symptoms(obsessive compulsive symptoms).2.MDD,AD and OCD outpatients are similar in plasma 5-HT,NE, ACTH,cortisol,and BDNF.A similar physiological basis may exist among the three diseases and it is difficult to distinguish diseases from each other with physiological index.3.MDD,AD and OCD outpatients are similar in attributional styles and self-esteem,which are trait-similar character.It is feasible to treat the three diseases with attributional retraining(AR) and self-esteem training. Outpatients with the three diseases are similar in psychoticism.MDD outpatients are of more introversion and less neuroticism than OCD outpatients.A vulnerable personality may affect the course and outcome of a disease and itself be a consequence of repeated episodes of illness. The outpatients with three diseases are similar in hopelessness but MDD outpatients feel less subjective well-being than AD patients.MDD and OCD outpatients have less resilience than AD patients.Targeted psychological intervention strategies could be designed according to patients with different resilience level to realize the empowerment role of psychotherapy.4.Social function impairment of MDD,AD and OCD outpatients are similar to each other.This study can provide reference for allocation of health care resources and improvement of the health insurance system. PartⅡ:Attributional retraining group therapy versus selective serotonin reuptake inhibitors for different mental disorders:symptomatic and physiopsychosocial effectsObjectiveThe primary purpose of the present study was to compare the effects on symptomatology and physiopsychosocial function of psychotherapy versus pharmacotherapy for different mental disorders.The secondary purpose was to discuss preliminarily the neurobiological mechanisms of psychotherapy.MethodsA forward-looking and intervention study design was used to compare psychotherapy and pharmacotherapy.The effects were compared on symptomatology and physiopsychosocial function of attributional retraining group therapy(ARGT) and selective serotonin reuptake inhibitors(SSRI) for different mental disorders.Outpatients were divided into ARGT group(n=63) and SSRI group(n=66) according to the sequence of entering the study.At the end of the study,54 outpatients in ARGT group and 55 outpatients in SSRI group completed the study.All subjects were detected of plasma 5-HT,NE,cortisol,ACTH and BDNF.Their psychosocial function was assessed with HAMD,HAMA, SDS,SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS. Yale-Brown obsessive compulsive scale(Y-BOCS) was employed only for OCD subjects.Results1.After treatment,both ARGT and SSRI groups were found significant reduction on the total scores of HAMD,HAMA,SDS and SAS.With mixed-effects linear model over 5 time points,it was showed that there were no significant differences in the total scores on HAMD and HAMA.Both groups reduced significantly in the total scores on Y-BOCS and obsessive and compulsive symptoms.There was no significant difference in score reduction between the two groups.2.Different regulations were found of ARGT and SSRI for the changes of HAMD and HAMA subscale symptoms over time:(1) Overall,SSRI group improved significantly than ARGT group at week 2 and ARGT group yielded well than SSRI group at week 6 and 8;(2) For HAMD subscale symptoms:ⅰ) The overall advantage factors of ARGT group were cognition disturbance,retardation and hopelessness.The overall advantage factors of SSRI group was diurnal variation subscales;ⅱ) The relative first-effect factors of ARGT group were cognition disturbance,retardation and hopelessness at week 6.The relative first-effect factors of SSRI group were sleep disturbance and anxiety at week 2.ⅲ) The treatment-specific change pattern of ARGT on HAMD subscale symptoms was:weight,diurnal variation(week 2)→sleep disturbance(week 4)→anxiety,cognition disturbance,retardation, hopelessness(week 6).The treatment-specific change pattern of SSRI was:sleep disturbance,anxiety,weight,diurnal variation(week 2)→cognition disturbance,retardation,hopelessness(week 8).(3) For HAMA subscale symptoms:ⅰ) The overall advantage factors of ARGT group were depressed symptoms and behavior at interview.The overall advantage factors of SSRI group was anxious emotions subscale;ⅱ) No the relative first-effect factor was found in ARGT group.The relative first-effect factors of SSRI group were anxious emotions, depressed symptoms,behavior at interview,somatic nervous symptoms and autonomic symptoms at week 2;ⅲ) The treatment-specific change pattern of ARGT on HAMA subscale symptoms was:internal organ symptoms,genito-urinary symptoms(week 2)→anxious emotions,depressed symptoms,behavior at interview,autonomic symptoms(week 4)→somatic nervous symptoms(week 6).SSRI improved effectively on all HAMA subscales at time 2 simultaneously.3.After treatment,ARGT group patients decreased plasma cortisol concentrations and SSRI group patients improved plasma 5-HT and BDNF significantly.ARGT group patients showed more reduction in plasma cortisol concentrations than SSRI group.4.After treatment,changes in ARGT group were significant in attributional styles,hopelessness,self-esteem,subjective well-being, resililence,extraversion,and neuroticism.Changes in SSRI group were significant in subjective well-being,resililence,extraversion,and neuroticism.ARGT group showed more reduction in the scores on attributional styles,self-esteem and psychoticism.5.Both therapies improved social function significantly.Patients in ARGT group obtained more improvement in social function.6.In ARGT group,there were negative correlation in the score reduction between 5-HT and HAMA,5-HT and SDSS,NE and SAS,and positive correlation between cortisol and SDS,resilience and NE, resilience and ACTH.In SSRI group,there were negative correlation between 5-HT and SDS and cortisol and extraversion.ConclusionsBased on results from this study and previous studies,the following conclusions were derived:1.In aspects of symptomatology,both psychotherapy and pharmacotherapy can reduce depressed,anxiuous and obsessive-compulsive symptomatology.Pharmacotherapy effects eariler than psychotherapy.Psychotherapy yields better in cortical symtoms. Pharmacotherapy yields better in subcortical symtoms.2.In aspects of neural anatomy,pharmacotherapy may target subcortical regions as the advantage sites with apparent bottom-up treatment-specific change pattern:subcortical regions(week 2) to cortices (week 8).Psychotherapy may target cortices as the advantage sites but seems to target different sites in different phases and techniques: improvement in periphery with emotion regulation skills and cognitive skills(week 2)→improvement in limbic system and brainstem with analysis of growth experience(week 4)→improvement in cortices with cognitive-behavioral skills(week 6).Both therapies result in a net change in cortical-subcortical pathways.The overall modulation of this complex system rather than any one focal regional change may be most critical for diseases remission. 3.In aspects of neurophysiology,psychotherapy can modulate plasma cortisol level,balance hypothalamic-pituitary-adrenal(HPA) axle function.Pharmacotherapy can upmodulate 5-HT level,playing a role through 5-HT function.The two therapies effect by different physiological way.However,both therapies may result in integrated effect by the interaction of HPA axel and 5-HT system.4.In aspects of neural plasticity,pharmacotherapy can stimulate activity-dependent synaptic plasticity in the neural networks by increasing molecular concentrations of BDNF.As a process of learning and memory,psychotherapy may increase experience-dependent brain plasticity.5.In aspects of psychosocial function,both therapies can improve personality,resilience,subjective well-being and social function with symptomatic reduction.Besides,psychotherapy can directly focus on attributional styles,self-esteem,personality and social function.The efficacy of psychotherapy may include the following four aspects:(1) changing in attributional styles;(2) improvement in self-esteem, personality and resilience;(3) reduction of symptoms and recovery of social function;(4) elimination of hopelessness and experience of well-being.With an all round improvement in symptomatology and physiopsychosocial function,psychotherapy can help patients positively restructure psychological diathesis and reduce their psychological vulnerability. PartⅢ:Comparison of symptomatic and physiopsychosocial effects of attribution retraining group therapy for major depression disorder,anxiety disorder and obsessive-compulsive disorderObjectiveTo compare the symptomatic and physiopsychosocial effects of ARGT for MDD,AD and OCD.MethodsA forward-looking and intervention study design was used to compare the symptomatic and physiopsychosocial effects of ARGT for MDD group(n=19),AD group(n=19) and OCD group(n=16).All subjects were detected plasma 5-HT,NE,cortisol,ACTH and BDNF. Their psychosocial functions were assessed with HAMD,HAMA,SDS, SAS,ASQ,SES,EPQ-RSC,CD-RISC,IWB,and SDSS.Results1.After treatment,all the three groups were found significant reduction on the total scores of HAMD,HAMA,SDS,SAS and the 21th item obsessive compulsive scores of HAMD.MDD group showed more reduction on HAMD than OCD group and obsessive compulsive scores than AD and OCD group.2.After treatment,all the three groups reduced plasma cortisol concentrations significantly.There was no significant difference in score reduction of 5 plasma substances among the three groups.3.After ARGT,MDD and OCD patients changed all the three attribution dimensions.GAD patients changed globality and stability attributional styles significantly.ARGT was effective in improving self-esteem for MDD,GAD and OCD patients.In MDD group,ARGT improved significantly in hopelessness,subjective well-being,resilience, psychoticism and extraversion.AD patients obtained significant improvement in resilience and neuroticism.The hopelessness was reduced significantly in OCD patients.4.All the three groups promoted social function significantly.There was no significant difference in score reduction of SDSS among the three groups.Conclusions1.ARGT is an effective psychotherapy for MDD,GAD and OCD.It brings positive improvement in symptomatology and physiopsychosocial function for patients with the three diseases.2.Comparatively speaking,MDD patients respond best to ARGT, followed by AD patients,and OCD patients obtain least among the three diseases.