Clark D M, Salkovskis P M, Hackmann A, Middleton H, Anastasiades P, Gelder M
Department of Psychiatry, University of Oxford, Warneford Hospital.
Br J Psychiatry. 1994 Jun;164(6):759-69. doi: 10.1192/bjp.164.6.759.
Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.
近期研究表明，认知疗法是治疗惊恐障碍的一种有效方法。然而，对于认知疗法与其他心理和药物治疗方法相比效果如何，人们却知之甚少。为了探究这个问题，64名惊恐障碍患者最初被分配到认知疗法组、应用放松疗法组、丙咪嗪组（平均每日233毫克），或者先等待3个月，之后再分配接受治疗。在治疗期间，患者在最初3个月最多接受12次治疗，在接下来的3个月最多接受3次强化治疗。丙咪嗪在6个月后逐渐停用。每种治疗都包括自我暴露的家庭作业。认知疗法和应用放松疗法的治疗时长为1小时。丙咪嗪治疗时长为25分钟。评估在治疗前/等待期以及3个月、6个月和15个月时进行。与等待名单组相比，所有三种治疗方法都有效。治疗方法之间的比较表明，在3个月时，认知疗法在大多数指标上优于应用放松疗法和丙咪嗪。在6个月时，认知疗法与丙咪嗪没有差异，并且在一些指标上两者都优于应用放松疗法。在6至15个月期间，一些丙咪嗪组患者复发。在15个月时，认知疗法再次优于应用放松疗法和丙咪嗪，但优于两者的指标数量比3个月时少。治疗结束时进行的认知测量是随访结果的显著预测指标。
