Otto M W, Pollack M H, Meltzer-Brody S, Rosenbaum J F
Behavior Therapy Unit, Massachusetts General Hospital, Boston 02114.
Psychopharmacol Bull. 1992;28(2):123-30.
The discontinuation of benzodiazepine treatment in patients with panic disorder may be associated with emergent withdrawal and anxiety symptoms, relapse of panic, and the inability to complete benzodiazepine taper. Although some patients may respond to slow taper strategies or the use of pharmacologic adjuncts, many continue to experience significant difficulties during benzodiazepine discontinuation. This paper presents a cognitive-behavioral conceptualization of benzodiazepine discontinuation difficulties, emphasizing "fear of fear" cycles. From this perspective the discontinuation process is seen as exposing panic disorder patients to somatic sensations associated with panic at a time when there is both increased anxiety and concern about re-emergence or worsening of panic episodes. As a consequence, patients may re-enter a cycle of catastrophic interpretations of symptoms, increased vigilance and fear, and panic. Cognitive-behavioral interventions may ameliorate discontinuation-associated difficulties and prevent the return of the panic disorder. Preliminary data supporting the efficacy of these interventions are described.
惊恐障碍患者停用苯二氮䓬类药物治疗可能会出现戒断反应和焦虑症状、惊恐复发以及无法完成苯二氮䓬类药物的逐渐减量。虽然一些患者可能对缓慢减量策略或使用药物辅助手段有反应，但许多患者在停用苯二氮䓬类药物期间仍会遇到重大困难。本文提出了一种关于停用苯二氮䓬类药物困难的认知行为概念化，强调“对恐惧的恐惧”循环。从这个角度来看，停药过程被视为在焦虑增加且担心惊恐发作再次出现或恶化的时候，让惊恐障碍患者暴露于与惊恐相关的躯体感觉中。因此，患者可能会重新进入对症状进行灾难性解读、警惕性和恐惧增加以及惊恐发作的循环。认知行为干预可能会改善与停药相关的困难，并防止惊恐障碍复发。文中描述了支持这些干预措施有效性的初步数据。
