Marcaurelle Roger, Bélanger Claude, Marchand André, Katerelos Theodora E, Mainguy Nicole
Department of Psychology, University of Quebec in Montreal, CP 8888, Succ. Centre-Ville, Montreal, Que., Canada H3C 3P8.
J Anxiety Disord. 2005;19(2):211-32. doi: 10.1016/j.janxdis.2004.01.005.
Twenty-six to forty percent of individuals suffering from panic disorder with agoraphobia (PDA) do not benefit significantly from cognitive-behavior therapy. Marital problems are among risk factors that may explain this limited impact. Some studies suggest that PDA treatment outcome is related to the couple's ability to communicate and solve problems during and after treatment. It may be also useful to further clarify the interplay of marital interpersonal variables with PDA severity before any intervention. This study aims at specifying the links between PDA symptom severity on the one hand and, on the other hand, marital adjustment, attachment style and personal problem-solving skills in both spouses. Results obtained from a group of 67 PDA patients (44 women and 23 men) and their partners showed that some PDA symptoms or comorbid depressive symptoms were more severe when both spouses independently scored low on problem-solving skills or marital adjustment, and when attachment style of PDA patients was insecure. Marital adjustment and difficulties in problem-solving, more specifically, avoidance of problem-solving activities in PDA patients, were the best predictors of PDA symptom severity. In light of these findings, a more complete program of problem-solving and acceptance strategies could be developed as part of a cognitive-behavior treatment of PDA. Other theoretical and clinical implications are discussed.
患有广场恐惧症的惊恐障碍（PDA）患者中，26%至40%的人无法从认知行为疗法中显著获益。婚姻问题是可能解释这种有限疗效的风险因素之一。一些研究表明，PDA的治疗效果与夫妻在治疗期间及之后的沟通和解决问题的能力有关。在进行任何干预之前，进一步阐明婚姻人际变量与PDA严重程度之间的相互作用可能也很有用。本研究旨在明确一方面PDA症状严重程度与另一方面夫妻双方的婚姻调适、依恋风格及个人解决问题能力之间的联系。对一组67名PDA患者（44名女性和23名男性）及其伴侣的研究结果表明，当夫妻双方在解决问题能力或婚姻调适方面独立得分较低，且PDA患者的依恋风格不安全时，一些PDA症状或共病的抑郁症状会更严重。具体而言，婚姻调适和解决问题的困难，即PDA患者对解决问题活动的回避，是PDA症状严重程度的最佳预测指标。鉴于这些发现，可以制定一个更完整的解决问题和接纳策略方案，作为PDA认知行为治疗的一部分。还讨论了其他理论和临床意义。
