Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
Depress Anxiety. 2010;27(1):5-11. doi: 10.1002/da.20601.
By comparing efficacious psychological therapies of different kinds, inferences about common effective treatment mechanisms can be made. We selected six therapies for review on the basis of the diversity of their theoretical rationales and evidence for superior efficacy: psychoanalytic psychotherapy, hypercapnic breathing training, hypocapnic breathing training, reprocessing with and without eye-movement desensitization, muscle relaxation, and cognitive behavior therapy. The likely common element of all these therapies is that they reduce the immediate expectancy of a panic attack, disrupting the vicious circle of fearing fear. Modifying expectation is usually regarded as a placebo mechanism in psychotherapy, but may be a specific treatment mechanism for panic. The fact that this is seldom the rationale communicated to the patient creates a moral dilemma: Is it ethical for therapists to mislead patients to help them? Pragmatic justification of a successful practice is a way out of this dilemma. Therapies should be evaluated that deal with expectations directly by promoting positive thinking or by fostering non-expectancy.
通过比较不同类型的有效心理疗法，可以推断出共同的有效治疗机制。我们根据理论基础和疗效优势证据的多样性，选择了六种疗法进行综述：精神分析心理疗法、高碳酸呼吸训练、低碳酸呼吸训练、再处理（是否带有眼动脱敏）、肌肉松弛和认知行为疗法。所有这些疗法的可能共同要素是，它们降低了对惊恐发作的即时预期，打破了恐惧害怕的恶性循环。在心理治疗中，改变预期通常被视为安慰剂机制，但对于惊恐症来说，它可能是一种特定的治疗机制。事实上，这种情况很少成为与患者沟通的理由，这就引发了一个道德困境：治疗师误导患者来帮助他们是否合乎道德？成功实践的实用主义理由为摆脱这一困境提供了出路。应该评估那些通过促进积极思考或培养非预期性来直接处理预期的疗法。
