恐飞症患者体内暴露期间的心理困扰与生理反应
Psychological Distress and Physiological Reactivity During In Vivo Exposure in People With Aviophobia.
作者信息
Busscher Bert, Spinhoven Philip, de Geus Eco J C
机构信息
From the VALK Foundation (Busscher), Leiden, the Netherlands; Institute of Psychology (Busscher, Spinhoven), Leiden University, Leiden, the Netherlands; Department of Psychiatry (Spinhoven), Leiden University Medical Center, Leiden, the Netherlands; and Department of Biological Psychology and EMGO+ Institute (de Geus), VU University & VU University Medical Center, Amsterdam, the Netherlands.
出版信息
Psychosom Med. 2015 Sep;77(7):762-74. doi: 10.1097/PSY.0000000000000209.
OBJECTIVES
Exposure is regarded to be a crucial component of therapies for phobias. According to emotional processing theory, the success of exposure therapy is predicted by activation of subjective and physiological fear responses and their within-session habituation and between-session adaptation. This study tested this prediction for aviophobia.
METHODS
Seventy-nine participants following a highly standardized treatment program for aviophobia provided self-reported and physiological (heart rate, respiratory sinus arrhythmia and pre-ejection period) measurements of fear activation, within-session habituation, and between-session adaptation during exposure to flight-related stimuli, a flight simulator, and during two real flights. Multiple regression analyses were conducted to examine whether these measurements predicted therapy outcome up to 3 years after finishing therapy, including number of flights flown in this period.
RESULTS
Both subjective and physiological arousal measurements indicated strong fear activation and large within-session habituation and between-session adaptation during exposure. Flight anxiety measures showed large improvements up to 3 years after treatment (η between 0.72 and 0.91). Lower self-reported anxiety during flight exposure was associated with lower flight anxiety after exposure (R = 0.15) and more flights flown (R = 0.14). Within-flight habituation or between-session adaptation of self-reported anxiety had no relationship with treatment outcome. Within-flight habituation of HR reactivity (R = 0.10) and respiratory sinus arrhythmia reactivity (R = 0.11) was associated with lower flight anxiety directly after the flight, but not on flight anxiety 3 years after finishing therapy or on long-term flying behavior.
CONCLUSIONS
The results provide only weak support for emotional processing theory. Low self-reported anxiety during in vivo flight exposure was the best predictor of successful long-term therapy outcome.
目的
暴露被视为恐惧症治疗的关键组成部分。根据情绪加工理论，暴露疗法的成功可通过主观和生理恐惧反应的激活及其在疗程内的习惯化和疗程间的适应性来预测。本研究对飞行恐惧症的这一预测进行了检验。
方法
79名参与者遵循高度标准化的飞行恐惧症治疗方案，在接触与飞行相关的刺激、飞行模拟器以及两次真实飞行期间，提供了自我报告的和生理（心率、呼吸性窦性心律失常和射血前期）的恐惧激活、疗程内习惯化和疗程间适应性测量数据。进行了多元回归分析，以检验这些测量数据是否能预测治疗结束后长达3年的治疗结果，包括在此期间飞行的次数。
结果
主观和生理唤醒测量均表明，在暴露期间存在强烈的恐惧激活以及显著的疗程内习惯化和疗程间适应性。飞行焦虑测量显示，治疗后长达3年有显著改善（η在0.72至0.91之间）。飞行暴露期间较低的自我报告焦虑与暴露后较低的飞行焦虑（R = 0.15）以及更多的飞行次数（R = 0.14）相关。自我报告焦虑的飞行内习惯化或疗程间适应性与治疗结果无关。心率反应性（R = 0.10）和呼吸性窦性心律失常反应性（R = 0.11）的飞行内习惯化与飞行后直接较低的飞行焦虑相关，但与治疗结束3年后的飞行焦虑或长期飞行行为无关。
结论
结果仅为情绪加工理论提供了微弱支持。体内飞行暴露期间较低的自我报告焦虑是长期治疗成功结果的最佳预测指标。
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