
Chinese General Practice ›› 2024, Vol. 27 ›› Issue (24): 2941-2953.DOI: 10.12114/j.issn.1007-9572.2024.0030
Special Issue: 指南/共识最新文章合辑
• Guidelines·Consensus • Next Articles
Received:2024-03-05
Revised:2024-04-20
Published:2024-08-20
Online:2024-05-08
Contact:
CHEN Jue
通讯作者:
陈珏
基金资助:
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2024.0030
| 推荐强度 | 证据级别 | 病因、治疗、预防 |
|---|---|---|
| A | 1a | 多个同质随机对照研究的系统综述 |
| 1b | 单个随机对照研究 | |
| 1c | "全或无"证据 | |
| B | 2a | 同质性队列研究的系统综述 |
| 2b | 单一的队列研究(包括低质量的随机对照研究,如随访率<80%) | |
| 2c | 结局性研究 | |
| 3a | 同质性病例对照研究的系统综述 | |
| 3b | 单独的病例对照研究 | |
| C | 4 | 病例系列 |
| D | 5 | 没有严格评价的专家意见,或完全基于生理学和基础研究 |
Table 1 The level of evidence graded by the OCEBM
| 推荐强度 | 证据级别 | 病因、治疗、预防 |
|---|---|---|
| A | 1a | 多个同质随机对照研究的系统综述 |
| 1b | 单个随机对照研究 | |
| 1c | "全或无"证据 | |
| B | 2a | 同质性队列研究的系统综述 |
| 2b | 单一的队列研究(包括低质量的随机对照研究,如随访率<80%) | |
| 2c | 结局性研究 | |
| 3a | 同质性病例对照研究的系统综述 | |
| 3b | 单独的病例对照研究 | |
| C | 4 | 病例系列 |
| D | 5 | 没有严格评价的专家意见,或完全基于生理学和基础研究 |
| 心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
|---|---|---|---|
| 认知行为治疗 | 第一阶段:自我监测,识别有问题的饮食模式,建立正常的饮食模式 第二阶段以认知为导向,包括教患者识别和重建关于其身体形象和饮食的适应不良想法(即"认知重建"),以及教授解决问题的技能,以更好地应对压力情况、人际互动和暴食的触发因素 第三阶段的重点是保持正常饮食,巩固新的认知和解决问题的能力,并学习预防复发的方法 | 12~24周,每周1次 | A1a |
| 辩证行为治疗 | 使BED患者发展出具有适应性的情绪调节技能,并能在日常生活中应用 | 1年,包含有(1)每周与治疗师的单独会谈;(2)每周在团体中的技能训练;(3)两次会谈期间通过电话进行的技能指导;(4)DBT治疗师团队每周一起讨论病情及治疗进展,以支持治疗(患者不参与) | B3a |
| 人际心理治疗 | 聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题 | 4~5个月,15~20次访谈 | B3a |
| 正念饮食觉知训练 | 正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解,包括觉察饥饿和饱胀感,将主要注意力放在饮食模式上 | 10次,包含有正念、正念饮食、情绪平衡、自我接纳 | B2b |
| 行为减重治疗 | 一种结构化的行为生活方式方法,让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者,应联合使用CBT或药物治疗 | B3a |
Table 2 Recommendations for psychotherapy in BED patients
| 心理治疗类型 | 治疗目标 | 推荐疗程 | 推荐强度/证据级别 |
|---|---|---|---|
| 认知行为治疗 | 第一阶段:自我监测,识别有问题的饮食模式,建立正常的饮食模式 第二阶段以认知为导向,包括教患者识别和重建关于其身体形象和饮食的适应不良想法(即"认知重建"),以及教授解决问题的技能,以更好地应对压力情况、人际互动和暴食的触发因素 第三阶段的重点是保持正常饮食,巩固新的认知和解决问题的能力,并学习预防复发的方法 | 12~24周,每周1次 | A1a |
| 辩证行为治疗 | 使BED患者发展出具有适应性的情绪调节技能,并能在日常生活中应用 | 1年,包含有(1)每周与治疗师的单独会谈;(2)每周在团体中的技能训练;(3)两次会谈期间通过电话进行的技能指导;(4)DBT治疗师团队每周一起讨论病情及治疗进展,以支持治疗(患者不参与) | B3a |
| 人际心理治疗 | 聚焦于识别和改变导致暴食问题发生、发展和持续的人际关系问题 | 4~5个月,15~20次访谈 | B3a |
| 正念饮食觉知训练 | 正念被整合到与食物渴望和饮食相关的日常活动中。其基于我们目前对食物摄入调节过程的了解,包括觉察饥饿和饱胀感,将主要注意力放在饮食模式上 | 10次,包含有正念、正念饮食、情绪平衡、自我接纳 | B2b |
| 行为减重治疗 | 一种结构化的行为生活方式方法,让患者在正常化和构建饮食模式的同时增加身体活动。适合BED合并肥胖的患者,应联合使用CBT或药物治疗 | B3a |
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