Hoyer Jürgen, Beesdo Katja, Gloster Andrew T, Runge Juliane, Höfler Michael, Becker Eni S
Clinical Psychology and Psychotherapy, Technische Universitat Dresden, Dresden, Germany.
Psychother Psychosom. 2009;78(2):106-15. doi: 10.1159/000201936. Epub 2009 Feb 13.
Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR).
In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures.
The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up.
This is the first study to show that a stand-alone exposure in sensu technique--WE--is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD.
担忧暴露（WE）是广泛性焦虑障碍（GAD）认知行为治疗的核心要素。其作为一种独立治疗方法（无需进一步的认知行为疗法干预）的疗效从未得到检验。我们旨在研究单独的担忧暴露是否与经实证支持的GAD独立治疗方法——应用放松（AR）同样有效。
在一项随机对照研究中，73名以GAD为主要诊断且符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的门诊患者被分配至担忧暴露组、应用放松组或等待名单对照组；在第二次随机化程序中，等待名单上的受试者被重新分配至担忧暴露组或应用放松组。治疗采用手册化方式（担忧暴露或应用放松各15节），包括6个月和1年的随访，以及末次观察结转和完成者分析，并对忠诚效应进行了控制。汉密尔顿焦虑量表和状态-特质焦虑量表用作主要结局指标。焦虑、担忧和抑郁的自我报告量表，包括对担忧的负面元认知和思维抑制，用作次要结局指标。
脱落率适中。汉密尔顿焦虑量表（标准化均数差值>1）和状态-特质焦虑量表（标准化均数差值>0.87）的治疗前后效应较大。达到高功能终末状态的患者比例分别为48%（担忧暴露组）和56%（应用放松组）。担忧暴露组和应用放松组在脱落率或治疗效果方面无差异。治疗效果在6个月和1年随访时保持稳定。
这是第一项表明一种独立的技术意义上的暴露——担忧暴露——对GAD治疗有效的研究。应用放松和担忧暴露似乎都是GAD有效的改变原则。
