Wardle J, Hayward P, Higgitt A, Stabl M, Blizard R, Gray J
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London, U.K.
Behav Res Ther. 1994 Feb;32(2):203-15. doi: 10.1016/0005-7967(94)90113-9.
In a study designed to evaluate the impact of benzodiazepine use on the outcome of behaviour therapy, 91, severe, chronic agoraphobics (46 BDZ users and 45 non-users) were randomly allocated on a double-blind basis to in vivo exposure with low-dose diazepam (ED) or placebo (EP). Drug doses were adjusted on the basis of weekly psychiatric assessments over weeks 1-4. Patients had 8 x 2 hr exposure sessions (weeks 5-12) and were then withdrawn from medication (weeks 13-16). Re-assessments were completed at weeks 4, 12 and 16, and follow-up assessments at approx 20, 46 and 72 weeks. In the analysis of the results, the clinical outcome was evaluated in relation to the therapeutic regime (ED vs EP) and prior BDZ use (users vs non-users). The results showed that the ED group had greater changes in anxiety than the EP group during the drug manipulation phases (anxiety increasing during BDZ withdrawal). There were no group differences in agoraphobic symptoms and no evidence that the outcome of the behavior therapy was significantly affected by concurrent BDZ treatment. There were significant improvements in agoraphobic symptoms over the treatment period, with no evidence for relapse of treatment gains on withdrawal from BDZ, nor for differential responses over the one year follow-up. Initial differences between users and non-users were less marked than expected, although there was a trend for more drop-outs among users across both ED and EP groups.
在一项旨在评估使用苯二氮䓬类药物对行为治疗结果影响的研究中，91名重度慢性广场恐惧症患者（46名使用苯二氮䓬类药物者和45名未使用者）被双盲随机分配接受低剂量地西泮体内暴露治疗（ED组）或安慰剂治疗（EP组）。在第1至4周，根据每周的精神科评估调整药物剂量。患者接受8次每次2小时的暴露治疗（第5至12周），然后停药（第13至16周）。在第4、12和16周完成重新评估，并在大约20、46和72周进行随访评估。在结果分析中，根据治疗方案（ED组与EP组）和先前使用苯二氮䓬类药物的情况（使用者与未使用者）评估临床结果。结果显示，在药物调整阶段，ED组的焦虑变化大于EP组（在停用苯二氮䓬类药物期间焦虑增加）。在广场恐惧症症状方面两组无差异，也没有证据表明同时使用苯二氮䓬类药物治疗会显著影响行为治疗的结果。在整个治疗期间广场恐惧症症状有显著改善，没有证据表明停用苯二氮䓬类药物后治疗效果会复发，也没有证据表明在一年的随访期内有不同的反应。使用者和未使用者之间的初始差异不如预期明显，尽管在ED组和EP组中，使用者的退出趋势更大。
