Clinic of Psychosomatics and Psychotherapy, Justus- Liebig-University Giessen.
Clinic of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg- August-University Goettingen.
Psychotherapy (Chic). 2014 Jun;51(2):224-45. doi: 10.1037/a0033815. Epub 2013 Dec 30.
Although there is evidence for the efficacy of psychodynamic therapy (PDT) in anxiety disorders, results are not yet satisfactory, for example, if rates of remission and response are considered. To address this problem, a unified psychodynamic protocol for anxiety disorders (UPP-ANXIETY) is proposed that integrates the treatment principles of those methods of PDT that have proven to be efficacious in anxiety disorders. In addition, this protocol is transdiagnostic, implying that it is applicable to various forms of anxiety disorders and related disorders (generalized anxiety disorder, social phobia, panic disorders, avoidant personality disorder). Based on supportive-expressive therapy, the UPP-ANXIETY represents an integrated form of psychodynamic therapy that allows for a flexible use of empirically supported treatment principles. UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance, (4) identifying the core conflict underlying anxiety, (5) focusing on the warded-off wish/affect, (6) modifying underlying internalized object relations, (7) changing underlying defenses and avoidance, (8) modifying underlying response of self, and (9) termination and relapse prevention. Some principles are regarded as core components to be used in every treatment (principles 3-8). A unified protocol for the psychodynamic treatment of anxiety disorders has several advantages, that is (1) integrating the most effective treatment principles of empirically supported psychodynamic treatments for anxiety disorders can be expected to further improve the efficacy of PDT; (2) using a unified protocol in efficacy studies has the potential to enhance the evidence-based status of PDT by aggregating the evidence; (3) a unified protocol will facilitate both training in PDT and transfer of research to clinical practice; and (4) thus, a unified protocol can be expected to have a significant impact on the health care system. We are planning to test the UPP-ANXIETY in a multicenter randomized controlled trial.
虽然有证据表明精神分析疗法（PDT）对焦虑症有效，但结果并不令人满意，例如，如果考虑缓解率和反应率。为了解决这个问题，提出了一种用于焦虑症的统一精神分析协议（UPP-ANXIETY），该协议整合了已被证明对焦虑症有效的 PDT 方法的治疗原则。此外，该协议具有跨诊断性，这意味着它适用于各种形式的焦虑症和相关障碍（广泛性焦虑症、社交恐惧症、惊恐障碍、回避型人格障碍）。基于支持表达疗法，UPP-ANXIETY 代表了一种灵活运用经验支持的治疗原则的综合形式的精神分析疗法。UPP-ANXIETY 包括以下 9 个治疗原则（模块）：（1）使患者适应心理治疗，（2）激发和设定治疗目标，（3）建立安全的帮助联盟，（4）确定焦虑的核心冲突，（5）关注被压抑的愿望/情感，（6）修改潜在的内化客体关系，（7）改变潜在的防御和回避，（8）改变潜在的自我反应，（9）结束和防止复发。一些原则被视为每个治疗都必须使用的核心组成部分（原则 3-8）。用于焦虑症的精神动力学治疗的统一方案具有以下几个优势，即（1）整合了经实证支持的针对焦虑症的精神动力学治疗中最有效的治疗原则，有望进一步提高 PDT 的疗效；（2）在疗效研究中使用统一的方案有可能通过汇集证据来提高 PDT 的循证地位；（3）统一的方案将促进精神动力学治疗的培训和研究向临床实践的转移；（4）因此，统一的方案有望对医疗保健系统产生重大影响。我们计划在一项多中心随机对照试验中测试 UPP-ANXIETY。
