Başoğlu M, Marks I M, Kiliç C, Brewin C R, Swinson R P
Institute of Psychiatry, Denmark Hill, London.
Br J Psychiatry. 1994 May;164(5):652-9. doi: 10.1192/bjp.164.5.652.
Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.
患有惊恐障碍伴广场恐惧症的患者接受为期8周的药物治疗（阿普唑仑或安慰剂）加心理治疗（暴露疗法或放松疗法）。在第8周治疗结束时，40名病情有显著改善的患者对其病情改善在多大程度上归因于药物治疗或自身努力进行了评估。在逐渐减药至第16周以及无治疗随访至第43周期间，那些在第8周时将病情改善归因于药物治疗且在不服药时应对能力信心较低的患者，与那些在第8周时将病情改善归因于治疗期间自身努力的患者相比，出现了更严重的戒断症状且病情改善的丧失更为明显。基线疾病严重程度、年龄较大、对药物治疗的期望较高以及治疗期间药物的更多副作用均预示着更多的外部归因（即归因于药物的作用），但并不能独立预测复发。与服用安慰剂的患者相比，服用阿普唑仑的患者有更多的药物归因。尽管药物归因在阿普唑仑组和安慰剂组中均能预测复发，但在阿普唑仑组中的预测更强。
