Bouchard Stéphane, Gauthier Janel, Nouwen Arie, Ivers Hans, Vallières Annie, Simard Sébastien, Fournier Thomas
Université du Québec en Outaouais and Centre Hospitalier Pierre-Janet, Canada.
J Behav Ther Exp Psychiatry. 2007 Sep;38(3):275-92. doi: 10.1016/j.jbtep.2006.08.002. Epub 2006 Dec 8.
The aim of this study is to assess if changes in dysfunctional beliefs and self-efficacy precede changes in panic apprehension in the treatment of panic disorder with agoraphobia. Subjects participated in a larger study comparing the effectiveness of cognitive restructuring and exposure. Four variables were measured: (a) the strength of each subject's main belief toward the consequence of a panic attack; (b) perceived self-efficacy to control a panic attack in the presence of panicogenic body sensations; (c) perceived self-efficacy to control a panic attack in the presence of panicogenic thoughts; and (d) the level of panic apprehension of a panic attack. Variables were recorded daily on a "0" to "100" scale using category partitioning. Multivariate time series analysis and "causality testing" showed that, for all participants, cognitive changes preceded changes in the level of panic apprehension. Important individual differences were observed in the contribution of each variable to the prediction of change in panic apprehension. Changes in apprehension were preceded by changes in belief in three cases, by changes in self-efficacy in six cases, and by changes in both belief and self-efficacy in the remaining three cases. This pattern was observed in participants in the exposure condition as well as those in the cognitive restructuring condition. These results provide more empirical support to the hypothesis that cognitive changes precede improvement. They also underlie the importance of individual differences in the process of change. Finally, this study does not support the hypothesis that exposure and cognitive restructuring operate through different mechanisms, namely a behavioral one and a cognitive one.
本研究的目的是评估在治疗伴有广场恐惧症的惊恐障碍时，功能失调信念和自我效能的变化是否先于惊恐担忧的变化。受试者参与了一项比较认知重建和暴露疗法有效性的大型研究。测量了四个变量：(a) 每个受试者对惊恐发作后果的主要信念强度；(b) 在存在引发惊恐的身体感觉时控制惊恐发作的感知自我效能；(c) 在存在引发惊恐的想法时控制惊恐发作的感知自我效能；以及 (d) 对惊恐发作的惊恐担忧程度。使用类别划分，每天以“0”至“100”的量表记录变量。多变量时间序列分析和“因果关系测试”表明，对于所有参与者，认知变化先于惊恐担忧水平的变化。在每个变量对惊恐担忧变化预测的贡献方面观察到了重要的个体差异。在三例中，担忧的变化先于信念的变化，在六例中先于自我效能的变化，在其余三例中先于信念和自我效能两者的变化。在暴露组和认知重建组的参与者中均观察到了这种模式。这些结果为认知变化先于改善这一假设提供了更多实证支持。它们还强调了变化过程中个体差异的重要性。最后，本研究不支持暴露疗法和认知重建通过不同机制起作用的假设，即行为机制和认知机制。
