Horst Ferdinand, Den Oudsten Brenda, Zijlstra Wobbe, de Jongh Ad, Lobbestael Jill, De Vries Jolanda
Department of Psychiatry, St. Elisabeth HospitalTilburg, Netherlands.
Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic DiseasesTilburg, Netherlands.
Front Psychol. 2017 Aug 18;8:1409. doi: 10.3389/fpsyg.2017.01409. eCollection 2017.
Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Two-arm (CBT and EMDR) parallel RCT in patients with PD ( = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT ( = 42) or EMDR therapy ( = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. EMDR therapy proved to be as effective as CBT for treating PD patients. Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134.
认知行为疗法（CBT）是治疗惊恐障碍（PD）患者的一种有效干预措施。从理论角度来看，眼动脱敏再处理（EMDR）疗法在PD治疗中可能也有用，原因如下：（1）惊恐发作可能被体验为危及生命；（2）PD特有的惊恐记忆类似于创伤后应激障碍（PTSD）中的创伤性记忆；（3）PD常继发于令人痛苦的生活事件之后。这项随机对照试验（RCT）的主要目的是比较EMDR疗法与CBT治疗PD的效果，并确定EMDR在减轻惊恐症状和改善生活质量（QOL）方面是否不劣于CBT。对84例PD患者进行双臂（CBT和EMDR）平行RCT。在基线期（T1）、最后一次治疗 session 结束后即刻（T2）以及治疗结束后3个月（T3）对患者进行测量。应用非劣效性检验（意向性分析的线性混合模型）。患者被随机分配接受13次每周60分钟的CBT治疗（n = 42）或EMDR疗法（n = 42）。采用标准方案。主要结局指标是T3时用恐旷症认知问卷（ACQ）、身体感觉问卷（BSQ）和活动量表（MI）测量的PD严重程度。次要结局指标是T3时用世界卫生组织生活质量简表（WHOQOL - Bref）测量的QOL。PD变量ACQ和BSQ的严重程度显示EMDR不劣于CBT，而MI的结果尚无定论（校正分析）。总体QOL以及一般健康、心理健康、社会关系和环境方面显示EMDR不劣于CBT，而身体健康方面尚无定论。EMDR疗法被证明在治疗PD患者方面与CBT同样有效。荷兰试验注册，编号3,134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 3134 。
