University of Pennsylvania, Department of Psychology, 425 S. University Avenue, Levin Building, 4th Floor, Philadelphia, PA, 19104, USA; Weill Cornell Medical College, Department of Psychiatry, New York, NY, USA.
University of Pennsylvania, Department of Psychology, 425 S. University Avenue, Levin Building, 4th Floor, Philadelphia, PA, 19104, USA.
J Psychiatr Res. 2019 Jul;114:34-40. doi: 10.1016/j.jpsychires.2019.04.009. Epub 2019 Apr 12.
It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities.
In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), symptomatic comorbidities of agoraphobia, MDD, GAD, and social anxiety disorder (SAD) were assessed pre-to-post treatment with the Anxiety Disorders Interview Schedule (ADIS). Comparative efficacy of CBT versus PFPP for treating comorbid disorders was tested at termination and 1 year's follow-up. Covariance between panic and comorbidity improvements was also analyzed.
Most treatment completers (n = 120) evidenced diagnostic remission of their comorbidity (range = 54-69%), which typically reflected a subclinical score on the ADIS (mean range = 1.3 to 1.8). These improvements were generally retained at follow-up. However, patients with MDD dropped out significantly more often (HR = 2.79). No significant symptom change or remission differences emerged between CBT and PFPP for any comorbidity at termination or at follow-up. Panic change was strongly related to improvements in agoraphobia (r = 0.70) and MDD (r = 0.53), moderately related for GAD (r = 0.31), and not significantly related for SAD (r = 0.20).
Patients completing panic-focused psychotherapies often experience meaningful remission for diagnoses of agoraphobia, MDD, GAD, and SAD, with no detectable differences between treatments, although sample sizes for the MDD and SAD comparisons were small. In addition, additional efforts may be needed to keep MDD-comorbid patients in treatment.
目前尚不清楚惊恐障碍（PD）的常见焦虑/情绪共病是否会随着针对惊恐的心理治疗而改善，也不清楚治疗这些共病的疗法之间是否存在疗效差异。
在一项针对伴有和不伴有广场恐惧症的 PD 的随机对照试验中，比较认知行为疗法（CBT）和惊恐聚焦心理动力学心理治疗（PFPP），使用焦虑障碍访谈表（ADIS）在治疗前和治疗后评估广场恐惧症、MDD、广泛性焦虑症（GAD）和社交焦虑障碍（SAD）的症状共病。在治疗结束时和 1 年随访时测试 CBT 与 PFPP 治疗共病障碍的相对疗效。还分析了惊恐与共病改善之间的协方差。
大多数治疗完成者（n=120）的共病诊断得到缓解（范围为 54%-69%），这通常反映了 ADIS 上的亚临床评分（均值范围为 1.3 至 1.8）。这些改善通常在随访中得到保留。然而，患有 MDD 的患者明显更经常脱落（HR=2.79）。在治疗结束时或随访时，CBT 和 PFPP 对任何共病均未出现显著的症状变化或缓解差异。惊恐的变化与广场恐惧症（r=0.70）和 MDD（r=0.53）的改善高度相关，与 GAD（r=0.31）中度相关，与 SAD（r=0.20）无显著相关。
完成惊恐聚焦心理治疗的患者经常经历与广场恐惧症、MDD、GAD 和 SAD 相关的诊断缓解，且在治疗之间没有可检测到的差异，尽管 MDD 和 SAD 比较的样本量较小。此外，可能需要额外的努力来让 MDD 共病患者继续接受治疗。
