D-环丝氨酸增强社交焦虑障碍暴露疗法的效果取决于暴露疗程的成功与否。
D-cycloserine enhancement of exposure therapy for social anxiety disorder depends on the success of exposure sessions.
机构信息
Department of Psychology, Southern Methodist University, USA.
出版信息
J Psychiatr Res. 2013 Oct;47(10):1455-61. doi: 10.1016/j.jpsychires.2013.06.020. Epub 2013 Jul 16.
OBJECTIVE
The evidence for the efficacy of D-cycloserine (DCS) for augmenting cognitive behavioral therapy (CBT) for anxiety disorders has been mixed. Guided by preclinical research and initial findings from a small-scale study involving humans, we tested the hypothesis that DCS enhancement of exposure therapy would be specific to successful exposure sessions.
METHOD
Medication-free adults with generalized social anxiety disorder (N = 145) received 50 mg of DCS or placebo 1 h before each of 5 exposure sessions that were part of a standardized 12-session group CBT protocol. Participants provided fear ratings at the beginning and just before the end of exposure exercises. Independent raters, blind to group assignment, administered the clinical global impression improvement and severity scales at each session and at posttreatment.
RESULTS
Mixed-effects analyses revealed that, among patients who reported low fear at the end of an exposure session, those who had received DCS evidenced significantly greater clinical improvement at the next session, relative to those who had received placebo. In contrast, when exposure end fear was high, patients receiving DCS exhibited less clinical improvement at the following session than patients receiving placebo. Similarly, patients who had received DCS evidenced lower clinical severity at posttreatment, relative to patients who had received placebo, only when their average end fear for medication-augmented sessions had been in the low to moderate range. Finally, these moderating effects of exposure success as indexed by end fear were not better accounted for by within-session extinction.
CONCLUSIONS
The efficacy of DCS for augmenting exposure-based CBT depends on the success of exposure sessions. These findings may help guide the development of an algorithm for the effective use of DCS for augmenting exposure-based CBT.
TRIAL REGISTRY
http://www.ClinicalTrials.gov, ID# NCT00633984, http://www.clinicaltrials.gov/ct2/show/NCT00633984.
目的
D-环丝氨酸（DCS）增强认知行为疗法（CBT）治疗焦虑障碍的疗效证据不一。基于临床前研究和一项涉及人类的小规模研究的初步发现，我们检验了这样一个假设，即 DCS 增强暴露疗法的效果将仅限于成功的暴露疗程。
方法
无药物治疗的广泛性社交焦虑障碍成年患者（N=145）在 5 次暴露疗程的每次疗程前 1 小时接受 50 毫克 DCS 或安慰剂，这些疗程是标准化的 12 次小组 CBT 方案的一部分。参与者在暴露练习开始和结束前提供恐惧评分。独立的评估者在每次疗程和治疗后均根据临床总体印象改善和严重程度量表进行评估，且对分组情况不知情。
结果
混合效应分析显示，在结束暴露疗程时报告恐惧程度较低的患者中，与接受安慰剂的患者相比，接受 DCS 的患者在下一次疗程中表现出显著更大的临床改善。相比之下，当暴露结束时的恐惧程度较高时，接受 DCS 的患者在接下来的疗程中表现出的临床改善小于接受安慰剂的患者。同样，与接受安慰剂的患者相比，仅当药物增强疗程的平均结束恐惧处于低至中度范围时，接受 DCS 的患者在治疗后表现出较低的临床严重程度。最后，这些由暴露结束时的恐惧程度作为指标的调节效应，不能更好地由会话内消退来解释。
结论
DCS 增强基于暴露的 CBT 的疗效取决于暴露疗程的成功程度。这些发现可能有助于指导有效使用 DCS 增强基于暴露的 CBT 的算法的发展。
试验注册
http://www.ClinicalTrials.gov，编号 NCT00633984，http://www.clinicaltrials.gov/ct2/show/NCT00633984。
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