Respiratory and Cognitive Mediators of Treatment Change in Panic Disorder: Evidence for Intervention Specificity
Respiratory and Cognitive Mediators of Treatment Change in Panic Disorder: Evidence for Intervention Specificity
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DOI：
10.1037/a0019552
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发表时间：
2010-10-01
影响因子：
5.9
通讯作者：
Hofmann, Stefan G.
中科院分区：
文献类型：
--
作者：
Meuret, Alicia E.;Rosenfield, David;Hofmann, Stefan G.
目的：惊恐障碍有许多理论，每一个都提出了一个独特的改变途径，导致治疗成功。然而，很少有人知道是否改善拟议的调解人确实与治疗结果，以及这些调解人是否具体到特定的治疗方式。我们在这项研究中的目的是使用纵向的，有节制的中介分析，分析理论上不同的干预措施的变化途径。方法：41名惊恐障碍和广场恐怖症患者被随机分配接受4周的训练，旨在改变呼吸（二氧化碳测定辅助呼吸训练）或惊恐相关的认知（认知训练）。呼吸（PCO2，呼吸率），症状评估，和一个模态非特异性介质（感知控制）的变化被认为是可能的介质。结果如下：惊恐症状严重程度和惊恐相关认知的降低以及感知控制的改善在两个治疗组中是显著且相当的。二氧化碳测定辅助呼吸训练，而不是认知训练，导致纠正从最初的低碳酸血症的正常碳酸水平。适度的调解和时间分析表明，在二氧化碳监测辅助呼吸训练，二氧化碳分压单向介导和之前的变化，症状评估和感知控制，并单向与恐慌症状的严重程度的变化。在认知训练中，症状评估的减少与感知控制和恐慌症状严重程度双向相关。此外，在两种治疗条件下，感知控制与恐慌症状严重程度呈双向相关。结论：研究结果表明，恐慌症状严重程度的降低可以通过不同的途径实现，与基础模型一致。
Objective: There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses. Method: Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO2, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators. Results: The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO2 unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions. Conclusion: The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models.