de Ruiter C, Ryken H, Garssen B, Kraaimaat F
Behav Res Ther. 1989;27(6):647-55. doi: 10.1016/0005-7967(89)90148-4.
The present study investigates the differential effectiveness of three treatment packages for agoraphobia. Patients suffering from panic disorder with agoraphobia (DSM-III-R) received one of three treatments: Breathing Retraining with Cognitive Restructuring (BRCR), graded self-exposure in vivo (EXP), or a combination of BRCR and EXP. Treatments consisted of 8 sessions. Assessment consisted of self-report measures for panic, phobic anxiety and avoidance, depression, general anxiety, somatic complaints and fear of body sensations, and of two respiratory measures (respiratory rate and alveolar pCO2). The treatments resulted in a reduction in symptomatology on all self-report measures, except panic frequency, and in a decrease in respiratory rate. There was no evidence for a differential efficacy for any of the treatments on any of the variables. Contrary to expectation, and at odds with findings from earlier studies, BRCR had no significant effect on panic frequency. A detailed comparison of sample characteristics of patients in our study and previous studies, did not yield insight into possible causes for the failure to replicate earlier results. The limited effectiveness of breathing retraining in reducing panic, as observed in the present study, leads us to conclude that the role of hyperventilation in panic is less important than previously thought.
本研究调查了三种治疗方案对广场恐惧症的不同疗效。患有伴有广场恐惧症的惊恐障碍（DSM-III-R）的患者接受了以下三种治疗之一：呼吸再训练与认知重建（BRCR）、逐级现场自我暴露（EXP），或BRCR与EXP的联合治疗。治疗包括8个疗程。评估包括针对惊恐、恐惧焦虑和回避、抑郁、广泛性焦虑、躯体不适以及对身体感觉的恐惧的自我报告测量，以及两项呼吸测量（呼吸频率和肺泡二氧化碳分压）。治疗使除惊恐发作频率外的所有自我报告测量的症状学有所减轻，并使呼吸频率降低。没有证据表明任何一种治疗对任何变量有不同的疗效。与预期相反，且与早期研究结果不一致的是，BRCR对惊恐发作频率没有显著影响。对我们研究中的患者与先前研究中的患者样本特征进行详细比较，并未洞察到未能重复早期结果的可能原因。如本研究中所观察到的，呼吸再训练在减轻惊恐方面的有限疗效使我们得出结论，即过度换气在惊恐中的作用不如先前认为的那么重要。
