Clum G A, Borden J W
Virginia Polytechnic Institute and State University.
Prog Behav Modif. 1989;24:192-222.
At this point in time, what do we know concerning the etiology and treatment of panic disorders? First, it appears that panic disorder is reached through multiple paths. Genetic vulnerability manifested through biological vulnerability appears to be a factor in at least some instances of this disorder. Environmental factors, such as interpersonal and other forms of stress, as well as various cognitive processing errors, also likely play a part in the development of panic. Whether these factors are additive or not or whether they combine in some other way to increase the probability that panic will develop is simply unknown at this time. A number of behavioral treatment techniques have developed within the past ten years as ways of ameliorating panic disorder. These techniques have been tied conceptually to etiological models of panic. In addition to exposure techniques, various physiologically based approaches (e.g., breathing retraining) and cognitively based approaches have been studied. These approaches target not only the avoidance behavior of agoraphobia, but also the panic attacks themselves. It appears safe to say that these techniques currently provide a viable alternative to pharmacological agents. Nonetheless, controlled studies that directly assess the relative merits of behavioral and pharmacological techniques are vitally needed. The present review uncovered a number of research questions and methodological issues. Unresolved etiological issues requiring clarification in the near future include the following: (1) Are stressful events important in the development of panic, or are they more incidentally related? Important in answering this question will be studies comparing panic disordered individuals with others suffering from such disorders as dysthymic reaction as well as other anxiety disorders. Also important will be longitudinal studies of individuals found to be suffering from panic disorder in order to determine whether exacerbations are stress related. (2) Are catastrophic thinking and other cognitive errors primary or secondary to panic disorder? That is, are such cognitive problems stable characteristics of panic disordered persons, or do they develop secondarily to panic disorders? (3) What determines whether an individual who develops panic disorder will also develop avoidance behavior? Along these same lines, will treatment approaches that successfully reduce panic have the secondary effect of reducing the prevalence of agoraphobia? (4) Are the behavioral techniques currently being developed to treat panic disorders viable with more severe types of agoraphobia, and will they add significantly to improvement rates when paired with exposure techniques?
目前，我们对惊恐障碍的病因和治疗了解多少呢？首先，惊恐障碍似乎是通过多种途径形成的。通过生物易感性表现出的遗传易感性似乎至少在某些该障碍病例中是一个因素。环境因素，如人际压力和其他形式的压力，以及各种认知加工错误，也可能在惊恐障碍的发展中起作用。目前尚不清楚这些因素是否具有累加性，或者它们是否以其他某种方式结合起来增加惊恐发作的可能性。在过去十年中，已经开发出了一些行为治疗技术来改善惊恐障碍。这些技术在概念上与惊恐障碍的病因模型相关联。除了暴露技术外，还研究了各种基于生理的方法（如呼吸再训练）和基于认知的方法。这些方法不仅针对广场恐惧症的回避行为，也针对惊恐发作本身。可以肯定地说，这些技术目前为药物治疗提供了一种可行的替代方案。尽管如此，迫切需要直接评估行为技术和药物技术相对优点的对照研究。本综述发现了一些研究问题和方法学问题。近期需要澄清的未解决病因问题包括以下几点：（1）应激事件在惊恐障碍的发展中是否重要，或者它们只是偶然相关？在回答这个问题时，比较惊恐障碍患者与患有心境恶劣反应等其他障碍以及其他焦虑障碍的患者的研究将很重要。对被发现患有惊恐障碍的个体进行纵向研究以确定病情加重是否与压力有关也很重要。（2）灾难性思维和其他认知错误是惊恐障碍的原发性还是继发性因素？也就是说，这些认知问题是惊恐障碍患者的稳定特征，还是在惊恐障碍之后才出现？（3）是什么决定了患惊恐障碍的个体是否也会出现回避行为？同样，成功减少惊恐发作的治疗方法是否会产生减少广场恐惧症患病率的次要效果？（4）目前正在开发的治疗惊恐障碍的行为技术对更严重类型的广场恐惧症是否可行，以及与暴露技术结合使用时是否会显著提高改善率？
