Wieder Gesine, Fischer Melanie S, Einsle Franziska, Baucom Donald H, Hahlweg Kurt, Wittchen Hans-Ulrich, Weusthoff Sarah
Institute for Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzer Strasse 46, 01187, Dresden, Germany; Department of Differential and Personality Psychology, Dresden University of Technology, Zellescher Weg 17, 01069, Dresden, Germany.
Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Strasse 20, 69115, Heidelberg, Germany; Faculty of Behavioural and Cultural Studies, Ruprecht-Karls University Heidelberg, Voßstrasse 2, 69115, Heidelberg, Germany.
Behav Res Ther. 2020 Dec;135:103728. doi: 10.1016/j.brat.2020.103728. Epub 2020 Sep 16.
Cognitive preparation plays a crucial role in CBT with exposure for panic disorder and agoraphobia. High emotional arousal while developing the exposure rationale might impair patients' cognitive capacities for processing information about treatment and impede therapeutic outcome.
This study investigates whether patients' vocally encoded emotional arousal, assessed by fundamental frequency (f), during rationale development is associated with premature treatment dropout, insight into the rationale, and symptom reduction.
Patients' (N = 197, mean age 36.1 years, 79.2% female) f during rationale development was measured based on treatment videos from a randomized controlled trial of CBT for panic disorder and agoraphobia. Insight was rater assessed. Symptom severity was self- and rater assessed at the beginning and end of therapy.
Higher f mean during rationale development was associated with lower probability of insight and less reduction in avoidance behavior. f was not associated with dropout. Insight was associated with lower probability of dropout and partially mediated the association between f and avoidance reduction.
This study highlights the importance of emotional arousal during cognitive preparation for exposure. Therapists should ensure that patients are not too highly aroused while learning about the exposure rationale as an important step in treatment.
认知准备在针对惊恐障碍和广场恐惧症的暴露疗法认知行为疗法（CBT）中起着关键作用。在阐述暴露疗法原理时出现的高度情绪唤起可能会损害患者处理有关治疗信息的认知能力，并阻碍治疗效果。
本研究调查在阐述原理过程中通过基频（f）评估的患者语音编码情绪唤起是否与过早退出治疗、对原理的理解以及症状减轻相关。
基于一项针对惊恐障碍和广场恐惧症的CBT随机对照试验的治疗视频，测量患者（N = 197，平均年龄36.1岁，79.2%为女性）在阐述原理过程中的f。对理解情况由评估者进行评估。在治疗开始和结束时，由患者自身和评估者对症状严重程度进行评估。
在阐述原理过程中较高的平均f与较低的理解概率以及回避行为减少较少相关。f与退出治疗无关。理解与较低的退出治疗概率相关，并且部分介导了f与回避减少之间的关联。
本研究强调了在暴露疗法的认知准备过程中情绪唤起的重要性。治疗师应确保患者在了解暴露疗法原理这一治疗中的重要步骤时，情绪唤起不会过高。
