Combined pharmacological and behavioral treatment for agoraphobia.
Combined pharmacological and behavioral treatment for agoraphobia.
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广场恐惧症的药物和行为联合治疗。
DOI：
10.1016/0005-7967(85)90011-7
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发表时间：
1985
影响因子：
4.1
通讯作者：
Christopher C. Gallen
中科院分区：
文献类型：
--
作者：
M. J. Telch;W.;Stewart Agras;C. Taylor;Walton T. Roth;Christopher C. Gallen
37 名严重残疾的广场恐惧症患者被随机分配至 (1) 组——不接触丙咪嗪。 (2) 丙咪嗪 + 暴露组或 (3) 安慰剂 + 暴露组。为了对丙咪嗪的药理作用进行更严格的测试，不受暴露于恐惧刺激的影响，在治疗的前 8 周期间，在丙咪嗪-无暴露条件下的受试者接受了抗暴露指令。在第 0、8 和 26 周时进行评估。 8周时，接受丙咪嗪联合暴露疗法的组比其他两组表现出更多的改善，并且是唯一表现出恐慌发作减少的组。接受丙咪嗪联合暴露疗法的组显示恐惧指数几乎没有改善，恐慌没有减少，但焦虑和烦躁情绪显着改善。在第 26 周，接受丙咪嗪 + 暴露联合治疗的受试者表现出进一步的改善，导致在许多不同的结果指标上，丙咪嗪 + 暴露明显优于安慰剂 + 暴露。接受丙咪嗪和抗暴露指令的受试者在随后的 18 周内表现出一些改善，其中抗暴露指令不再有效。然而，该组和安慰剂+暴露组都没有表现出恐慌发作的减少。本试验的结果支持了强烈暴露与丙咪嗪相结合的有益效果，但对丙咪嗪通过药物阻断惊恐发作发挥作用的论点提出了质疑。提出了关于丙咪嗪作用方式的替代假设。
Thirty-seven severely-disabled agoraphobics were randomly assigned to (1) Imipramine-no exposure. (2) Imipramine + exposure or (3) Placebo + exposure groups. To provide a more stringent test of the pharmacological effects of imipramine independent of exposure to phobic stimuli,Ss in the Imipramine-no exposure condition received antiexposure instructions during the first 8 weeks of therapy. Assessments were conducted at 0, 8 and 26 weeks. At 8 weeks, the group receiving imipramine combined with exposure therapy displayed more improvement than the other two groups, and was the only group to show a reduction in panic attacks.Ss receiving imipramine with antiexposure instructions showed little improvement on phobic indices, no reduction in panic, but significant improvement in anxiety and dysphoric mood. At 26 weeksSs receiving the combined imipramine + exposure treatment exhibited further improvement resulting in a significant superiority of Imipramine + exposure over Placebo + exposure across a number of different outcome indices.Ss who had received imipramine with antiexposure instructions showed some improvement during the subsequent 18 weeks in which the antiexposure instructions were no longer in effect. However, neither this group nor the Placebo + exposure group showed a reduction in panic attacks. The results of the present trial provide support for the beneficial effects of combining intensive exposure with imipramine, but call into question the thesis that imipramine exerts its effect through a pharmacological blocking of panic attacks. Alternative hypotheses concerning the mode of action of imipramine are presented.