Noda Yumiko, Nakano Yumi, Lee Kiyoe, Ogawa Sei, Kinoshita Yoshihiro, Funayama Tadashi, Watanabe Norio, Chen Junwen, Noguchi Yuka, Kataoka Miyako, Suzuki Masako, Furukawa Toshi A
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
BMC Psychiatry. 2007 Dec 10;7:70. doi: 10.1186/1471-244X-7-70.
Cognitive model of panic disorder have proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations. Cognitive-Behavioral Therapy (CBT) for panic disorder aims to change these catastrophic cognitions. CBT intervention successfully caused reduction of catastrophic cognitions and symptomatic improvement in the majority of cases. However there are some patients who fail to modify their catastrophic cognitions or rather experience an increase in them during CBT treatment. It is clinically and theoretically important to understand about cognitive sensitization of panic disorder during CBT sessions. The purpose of the present study is 1) to clarify the baseline characteristics of panic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment, and 2) to examine the course of symptomatic changes for them.
Of ninety-five outpatients with panic disorder started the group CBT program for treatment of panic disorder, seventy-nine completer were classified as "cognitively sensitized (CS)" or "cognitive responding (CR)" or "no-responder" according to the difference of the Agoraphobic Cognitions Questionnaire score across treatment. We compared the CS and CR patients in terms of their baseline clinical characteristics. Then we assessed the symptomatic and functional changes for both groups.
At the start of the CBT program, despite of the same degree of panic disorder severity, CS scored significantly lower on ACQ score than CR. CS also showed significantly lower score on anticipatory anxiety compared to CR. At the end of treatment CS showed significant improvement in severity of panic disorder, although the degree of improvement was smaller than that for CR. Then CS would progressively reduce their agoraphobic fear and avoidance, and would improve their functional impairment up to three month of follow-up.
Panic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment could nonetheless gradually improve. They showed a relatively low level of catastrophic cognition and anticipatory anxiety before starting the CBT program. We might conclude that temporary sensitization of catastrophic cognition may be necessary before improvement especially among those with initially low catastrophic body sensation fears and that we need not be concerned too much with temporary increase in catastrophic cognition in the process of CBT for panic disorder.
惊恐障碍的认知模型提出，惊恐发作源于对某些身体感觉的灾难性误解。惊恐障碍的认知行为疗法（CBT）旨在改变这些灾难性认知。在大多数情况下，CBT干预成功地减少了灾难性认知并改善了症状。然而，有一些患者在CBT治疗期间未能改变他们的灾难性认知，甚至灾难性认知有所增加。了解CBT治疗期间惊恐障碍的认知致敏在临床和理论上都很重要。本研究的目的是：1）阐明通过CBT治疗会经历灾难性认知致敏的惊恐障碍患者的基线特征，2）研究他们症状变化的过程。
在95名开始接受惊恐障碍团体CBT治疗的门诊患者中，79名完成治疗者根据治疗前后广场恐惧症认知问卷得分的差异被分为“认知致敏（CS）”组、“认知反应（CR）”组或“无反应者”组。我们比较了CS组和CR组患者的基线临床特征。然后我们评估了两组患者的症状和功能变化。
在CBT治疗开始时，尽管惊恐障碍严重程度相同，但CS组的ACQ得分显著低于CR组。与CR组相比，CS组的预期焦虑得分也显著更低。治疗结束时，CS组的惊恐障碍严重程度有显著改善，尽管改善程度小于CR组。然后，CS组会逐渐减少广场恐惧症的恐惧和回避行为，并在随访的三个月内改善其功能损害。
通过CBT治疗会经历灾难性认知致敏的惊恐障碍患者仍然可以逐渐改善。他们在开始CBT治疗前表现出相对较低水平的灾难性认知和预期焦虑。我们可以得出结论，在改善之前，尤其是在那些最初对灾难性身体感觉恐惧较低的患者中，灾难性认知的暂时致敏可能是必要的，而且在惊恐障碍的CBT治疗过程中，我们不必过于担心灾难性认知的暂时增加。
