Goldberg C
Indiana University-Purdue University at Indianapolis, Department of Psychology 46202, USA.
Psychiatr Q. 1998 Spring;69(1):23-44. doi: 10.1023/a:1022181206728.
The cognitive model of panic and cognitive-behavioral therapy were evaluated. It was argued that the cognitive model is not clear about the definition of threat, and that panic is evoked by the fear of the dissolution of the self. Furthermore, panic attacks will not lead to panic disorder unless the individual is experiencing general anxiety and is concerned with his/her physical or mental state. Controlled studies have demonstrated that cognitive-behavioral therapy is superior to other treatments for panic--85% of patients are panic-free at posttreatment and improvements are maintained at follow-up. However, 26% of waiting-list controls are also panic-free making the net percentage of panic-free treated patients 59%. There is room for improvement in at least 50% of patients, and a substantial number of patients continue to take medication and seek additional treatment. There is a need to determine the essential components of cognitive-behavioral therapy. It was predicted that exposure will prove to be the most crucial component. Exposure to phobic situations and interoceptive cues should be extended to the underlying causes of panic disorder, such as concerns with identity and dependency needs.
对惊恐障碍的认知模型和认知行为疗法进行了评估。有人认为，认知模型对威胁的定义不明确，惊恐是由对自我解体的恐惧引发的。此外，惊恐发作不会导致惊恐障碍，除非个体正经历一般性焦虑并关注自己的身体或精神状态。对照研究表明，认知行为疗法在治疗惊恐障碍方面优于其他疗法——85%的患者在治疗后不再惊恐，且改善情况在随访中得以维持。然而，26%处于等待名单的对照者也不再惊恐，这使得接受治疗后不再惊恐的患者净比例为59%。至少50%的患者仍有改善空间，相当一部分患者继续服药并寻求额外治疗。有必要确定认知行为疗法的关键组成部分。据预测，暴露将被证明是最关键的组成部分。对恐惧情境和内感受性线索的暴露应扩展到惊恐障碍的潜在原因，如对身份认同和依赖需求的关注。
