Powers Mark B, Smits Jasper A J, Whitley Diana, Bystritsky Alexander, Telch Michael J
Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, the Netherlands.
J Consult Clin Psychol. 2008 Jun;76(3):478-90. doi: 10.1037/0022-006X.76.3.478.
In this investigation, the authors examined the effect of attributional processes concerning medication taking on return of fear following exposure-based treatment. Participants (87% undergraduate students and 13% community volunteers) displaying marked claustrophobic fear (N = 95) were randomly allocated to a waitlist condition, a psychological placebo condition, a 1-session exposure-based treatment, or the same exposure treatment given in conjunction with an inactive pill. Attributions concerning medication taking were manipulated by further randomly assigning participants in the exposure-based treatment plus pill condition to 1 of 3 instructional sets immediately following treatment completion and posttreatment assessment: (1) The pill was described as a sedating herb that likely made exposure treatment easier; (2) the pill was described as a stimulating herb that likely made exposure treatment more difficult; or (3) the pill was described as a placebo that had no effect on exposure treatment. Return of fear rates for the 3 conditions were 39%, 0%, and 0%, respectively. Moreover, the deleterious effects of the sedation instructions were mediated by reduced self-efficacy. These findings highlight the importance of assessing patient attributions regarding the improvements achieved with combined exposure-based and pharmacological treatments for anxiety disorders.
在本研究中，作者考察了服药归因过程对基于暴露疗法的治疗后恐惧复发的影响。表现出明显幽闭恐惧症的参与者（87%为本科生，13%为社区志愿者）（N = 95）被随机分配到等待名单组、心理安慰剂组、1节基于暴露的治疗组，或与无活性药丸联合使用的相同暴露治疗组。通过在治疗结束和治疗后评估后，将基于暴露治疗加药丸组的参与者进一步随机分配到3种指导组中的1组，来操纵服药归因：（1）药丸被描述为一种镇静草药，可能使暴露治疗更容易；（2）药丸被描述为一种刺激性草药，可能使暴露治疗更困难；或（3）药丸被描述为对暴露治疗无影响的安慰剂。这3种情况的恐惧复发率分别为39%、0%和0%。此外，镇静说明的有害影响是由自我效能降低介导的。这些发现强调了评估患者对焦虑症联合暴露疗法和药物治疗所取得改善的归因的重要性。
