Marks I
Psychother Psychosom. 1986;46(1-2):35-44. doi: 10.1159/000287960.
The two most-used treatments for phobic and obsessive-compulsive disorders are exposure and drugs. In exposure therapy, the patient is persuaded to re-enter the phobia- or ritual-evoking situation and to stay there despite the ensuing panic until it starts to subside, which may take 1 h or more. The patient does this repeatedly and systematically, noting outcome in an exposure-homework diary which the clinician reviews. Controlled studies show that such self-exposure treatment (requiring little time from the clinician) has lasting value. Only a minority of cases need additional therapist-aided exposure. Antidepressants are useful adjuvants to exposure in dysphoric phobics and ritualisers. No antidepressant is clearly superior to any other. Relapse on stopping medication is a problem. Neither beta-blockers nor benzodiazepines are yet of proven lasting value for these syndromes. It is too easy to forget that drugs have unpleasant side-effects which are not seen with exposure therapy.
针对恐惧症和强迫症最常用的两种治疗方法是暴露疗法和药物治疗。在暴露疗法中，患者会被劝说重新进入引发恐惧或仪式行为的情境，并在随之而来的恐慌中停留，直到恐慌开始消退，这可能需要1小时或更长时间。患者反复且系统地这样做，并在暴露治疗作业日记中记录结果，临床医生会查看这本日记。对照研究表明，这种自我暴露治疗（所需临床医生的时间很少）具有持久的价值。只有少数病例需要额外的治疗师辅助暴露治疗。对于伴有烦躁情绪的恐惧症患者和仪式行为患者，抗抑郁药是暴露疗法的有用辅助药物。没有一种抗抑郁药明显优于其他药物。停药后复发是一个问题。β受体阻滞剂和苯二氮䓬类药物对这些综合征尚未被证明具有持久价值。人们很容易忘记药物有不良副作用，而暴露疗法则不会出现这些副作用。
