Barlow David H, Allen Laura B, Choate Molly L
Boston University.
Boston University.
Behav Ther. 2016 Nov;47(6):838-853. doi: 10.1016/j.beth.2016.11.005. Epub 2016 Nov 10.
Over 40 years of development of cognitive behavioral approaches to treating anxiety and related emotional disorders have left us with highly efficacious treatments that are increasingly widely accepted. Nevertheless, these manualized protocols have become numerous and somewhat complex, restricting effective training and dissemination. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structure among these disorders supercedes differences. This suggests the possibility of distilling a set of psychological procedures that would comprise a unified intervention for emotional disorders. Based on theory and data emerging from the fields of learning, emotional development and regulation, and cognitive science, we identify three fundamental therapeutic components relevant to the treatment of emotional disorders generally. These three components include (a) altering antecedent cognitive reappraisals; (b) preventing emotional avoidance; and (c) facilitating action tendencies not associated with the emotion that is dysregulated. This treatment takes place in the context of provoking emotional expression (emotional exposure) through situational, internal, and somatic (interoceptive cues), as well as through standard mood-induction exercises, and differs from patient to patient only in the situational cues and exercises utilized. Theory and rationale supporting this new approach are described along with some preliminary experience with the protocol. This unified treatment may represent a more efficient and possibly a more effective strategy in treating emotional disorders, pending further evaluation.
在认知行为疗法治疗焦虑及相关情绪障碍的四十多年发展历程中,我们拥有了越来越被广泛接受的高效治疗方法。然而,这些手册化的治疗方案数量众多且有些复杂,限制了有效的培训和传播。对情绪障碍本质的深入理解表明,这些障碍在病因和潜在结构上的共性超过了差异。这表明有可能提炼出一套心理程序,构成针对情绪障碍的统一干预方法。基于学习、情绪发展与调节以及认知科学领域出现的理论和数据,我们确定了三个与一般情绪障碍治疗相关的基本治疗要素。这三个要素包括:(a)改变先行认知重评;(b)防止情绪回避;(c)促进与失调情绪无关的行动倾向。这种治疗是在通过情境、内在和躯体(内感受性线索)以及标准情绪诱导练习激发情绪表达(情绪暴露)的背景下进行的,并且仅在使用的情境线索和练习方面因患者而异。文中描述了支持这种新方法的理论和基本原理,以及该治疗方案的一些初步经验。在等待进一步评估期间,这种统一治疗可能代表了一种在治疗情绪障碍方面更高效且可能更有效的策略。