Bakker Abraham, Spinhoven Philip, van der Does A J Willem, van Balkom Anton J L M, van Dyck Richard
Department of Psychiatry and Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Psychother Psychosom. 2002 Mar-Apr;71(2):85-9. doi: 10.1159/000049350.
In this study the effects of treatment with cognitive therapy, antidepressants or pill-placebo on the locus of control orientation in panic disorder patients were analysed, as well as the relation of this panic locus of control with panic frequency and cognitive measures of panic.
A Multidimensional Anxiety Locus of Control scale (MALC) was developed and completed with other measures (ACQ and BSQ) before and after treatment. Patients also kept a panic diary.
Four subscales were derived from the MALC: one Internal, and three external (a Chance, a Medication, and a Therapist) locus of anxiety control orientation scales. Cognitive therapy was superior over pill-placebo on most outcome measures whereas antidepressants were only superior in reducing the number of panic attacks. Treatment with cognitive therapy resulted in an increase of 'internal' anxiety control orientation and a decrease of 'chance' and 'medication' orientation, in comparison with antidepressant therapy. The residualized gain scores on the MALC subscales correlated with clinical improvement in subjects treated with cognitive therapy only.
Results suggest that the locus of control orientation is important in evaluating the differential effects of treatments in panic disorder. A differential effect on panic locus of control in favor of cognitive therapy in comparison to medication was found.
在本研究中，分析了认知疗法、抗抑郁药或安慰剂治疗对惊恐障碍患者控制源取向的影响，以及这种惊恐控制源与惊恐发作频率和惊恐认知测量之间的关系。
开发了多维焦虑控制源量表（MALC），并在治疗前后结合其他测量方法（ACQ和BSQ）进行填写。患者还记录了惊恐日记。
从MALC中得出四个分量表：一个内控分量表，以及三个外控分量表（一个机遇、一个药物和一个治疗师焦虑控制取向量表）。在大多数结果测量中，认知疗法优于安慰剂，而抗抑郁药仅在减少惊恐发作次数方面更具优势。与抗抑郁药治疗相比，认知疗法治疗导致“内控”焦虑控制取向增加，“机遇”和“药物”取向减少。MALC分量表上的残差增益分数仅与接受认知疗法治疗的受试者的临床改善相关。
结果表明，控制源取向在评估惊恐障碍治疗的差异效应中很重要。发现与药物治疗相比，认知疗法对惊恐控制源有差异效应。
