Dusseldorp Elise, Spinhoven Philip, Bakker Abraham, van Dyck Richard, van Balkom Anton J L M
Data Theory Group, Department of Education, Leiden University, Leiden, The Netherlands.
Psychother Psychosom. 2007;76(3):154-61. doi: 10.1159/000099842.
Beliefs about the controllability of a disorder may be relevant in the causation, maintenance and treatment of disorders. We investigated whether congruence between patients' beliefs about controllability of a panic disorder and the type of treatment provided predicted outcome.
The differential effectiveness of cognitive therapy and antidepressant treatment (paroxetine or clomipramine) was investigated in a sample of 129 panic disorder patients in a 12-week, pretest posttest placebo-controlled study. Panic frequency, agoraphobic avoidance, anxiety, depression, and disability were measured with various validated interviewer and self-report measures. Beliefs about controllability were measured with the Multidimensional Anxiety Locus of Control Scale measuring an internal, chance, therapist and medication locus of control. In order to analyze aptitude-treatment interactions a new strategy called the Regression Trunk Approach was used in addition to classical hierarchical multiple regression analysis.
Using the Regression Trunk Approach we found that locus of control orientation (LOC) predicted the differential effectiveness of cognitive therapy. Those patients with a medium internal LOC who received cognitive therapy performed significantly better than all patients who received a placebo pill on 8 of the 10 outcome variables. We did not find a differential LOC effect for antidepressant treatment. No evidence for aptitude-treatment interactions using hierarchical multiple regression analysis was found.
Moderately strong beliefs about self-control of panic disorder congruent with the cognitive intervention provided seem to moderate treatment effectiveness. Future studies must be more attentive to the nonlinear effects of patient characteristics on the outcome of different types of treatments.
关于疾病可控性的信念可能与疾病的病因、维持及治疗相关。我们调查了惊恐障碍患者对可控性的信念与所提供治疗类型之间的一致性是否能预测治疗结果。
在一项为期12周、有前测和后测且设安慰剂对照的研究中，对129名惊恐障碍患者样本进行了认知疗法与抗抑郁治疗（帕罗西汀或氯米帕明）的疗效差异研究。使用多种经过验证的访谈者和自我报告测量方法来测量惊恐发作频率、场所恐惧症回避、焦虑、抑郁及功能障碍。通过多维焦虑控制源量表测量对可控性的信念，该量表测量内部、机遇、治疗师及药物控制源。为了分析能力-治疗相互作用，除了经典的分层多元回归分析外，还使用了一种名为回归主干法的新策略。
使用回归主干法，我们发现控制源取向（LOC）预测了认知疗法的疗效差异。那些具有中等内部LOC且接受认知疗法的患者在10个结局变量中的8个上，其表现显著优于所有接受安慰剂丸的患者。我们未发现抗抑郁治疗存在LOC差异效应。使用分层多元回归分析未发现能力-治疗相互作用的证据。
与所提供的认知干预相一致的、对惊恐障碍自我控制的适度强烈信念似乎能调节治疗效果。未来的研究必须更加关注患者特征对不同类型治疗结果的非线性影响。
