- 期刊
To what extent would cognitive-behavioral therapies be an efficient method of intervention for Tourette syndrome in children?
認知行為治療作為妥瑞症兒童患者有效療法之範疇
摘要
Tourette syndrome (TS) can be defined as a complex, genetic and neuropsychiatric disorder. It onsets with multiple motor and vocal tics at a mean age of around 6 to 7 and continues for more than one year, usually with different kinds of comorbidities, which seriously hinder the individual's performance and potential achievements. Medication is the most common treatment method for TS but it is often discontinued due to its adverse side-effects. The study aimed to explore the ability and limitation of psychological intervention from the basis of cognitive-behavioral therapy (CBT) concepts of TS in children alongside pharmacotherapy. The research may meaningfully fulfill the strengthening of a comprehensive review towards TS among existing studies, particularly between CBT and pharmacotherapy. It assists by aiding patients and families to decide on the treatment matrix while inspiring further research of TS. The study applied a literature-based research methodology to systemically review the research question: To what extent would CBTs be an efficient method of intervention for TS in children? Two contemporary and highly evidence-based CBTs: Comprehensive Behavioral Intervention of Tics (CBIT) and Collaborative Problem Solving (CPS) were fully examined and discussed with references and connections to pharmacotherapy. The study revealed that: (1) CBT is able to be an efficient treatment method for TS alongside pharmacotherapy, with particularly positive results usually after a post-treatment duration of 6 months; (2) The most outstanding implication of CBT is restoration of psychosocial autonomy and empowerment in children through management protocols of psychology while being side-effect free, when compared with pharmacotherapy; (3) CBT is not perfect to be the sole or one-for-all treatment method, and presents hurdles for practice and adaptation; and (4) There is grounds for CBT and pharmacotherapy to provide assistance to each other in terms of treatment benefits. The study argues that the idea of CBT should be taken into account as an aspect of holistic treatment for TS. This study suggests that a complementary and synergic concept integrating the CBIT and CPS, which if adopted with cognitive and behavioral components will as well as bridging interdisciplinary treatment ideas between CBT and pharmacotherapy, create the optimum beneficial treatment for the children with TS.
並列摘要
妥瑞症（Tourette syndrome）係多重及遺傳性神精異常，好發於6至7歲間，症狀為不自主的抽搐與發出聲響，嚴重影響日常表現與發展，目前最普遍的治療方式為「藥物療法」（pharmacotherapy）。本研究經由檢視妥瑞症現有相關研究，探討「心理療法」（psychotherapy）之「認知行為治療」（cognitive-behavioral therapies, CBTs）應用於兒童患者之效能與限制，期對妥瑞症病患及家屬在選擇適當療法之分析基礎上作出貢獻，推啟妥瑞症的進一步研究。本研究以「文獻研究法」（literature-based research methodology）系統地檢視「認知行為治療」應用於妥瑞症兒童患者之有效性範疇，並以目前經實證之「全面行為介入療法」（Comprehensive Behavioral Intervention of Tics, CBIT）與「合作解決問題療法」（Collaborative Problem Solving, CPS）兩項認知行為療法進行相關分析與驗證。本研究發現（1）「認知行為療法」為「藥物療法」外，對妥瑞症兒童患者確具療效之療法，多數患者接受治療後約6個月，仍可維持相當療效；（2）「認知行為療法」之特點，係透過心理學學理，重建兒童之社會心理（psychosocial）自主與強化，且無「藥物療法」導致的副作用；（3）「認知行為療法」並非全然完善，作為「單獨」或「一體適用」之療法，仍有不足之處，加以兒童患者對「認知行為療法」存有操作及適應的相對難度；（4）「認知行為療法」與「藥物療法」兩者，彼此存在相互增益空間，有助提升妥瑞症療效。本研究建議「認知行為療法」應被納入妥瑞症兒童患者整體（holistic）治療方案，並提出「互補與綜效」（complementary and synergic）之概念性思維，以期整合「全面行為介入療法」與「合作解決問題療法」所立基之「行為治療」（behavioral therapy）與「認知治療」（cognitive therapy），配合「藥物療法」，建構「整合與跨領域」（integrated and interdisciplinary）之最適療效。