Effectiveness of cognitive behavior therapy on panic disorder

本研究旨在探讨认知行为疗法对惊恐障碍的治疗效果。本研究包括三个研究，第一个研究是在对15例恐慌症患者进行认知行为治疗的基础上，制定了惊恐障碍的标准化认知行为治疗方案；第二个研究是从治疗前后的比较以及与候补名单对照组的比较的角度，考察了标准化认知行为治疗对躁狂障碍患者的疗效。此外，暴露和认知重建的有效性是认知行为治疗的主要治疗成分，采用拆解实验设计进行了研究。结果表明，标准化认知行为疗法能有效缓解惊恐障碍的多方面症状。此外，暴露能有效降低广场恐怖症，认知重建能有效降低主观焦虑。在本研究的第三部分，从生理变化的角度考察了认知行为疗法的有效性。采用正电子发射计算机断层扫描(PET)观察标准化认知行为治疗前后脑内糖代谢的变化。认知行为治疗后，作为恐惧网络触发源的海马、小脑、桥脑和壳核的糖代谢显著降低，而内侧前额叶皮质抑制杏仁核能力增强的脑区糖代谢显著增加。CBT方案是治疗惊恐障碍伴广场恐怖症的有效方法，从临床心理学角度探讨认知行为疗法对惊恐障碍患者的治疗效果。

The purpose of this study was to investigate the effectiveness of the cognitive behavior therapy to panic disorder. This research includes three studies.In the first study, the standardized cognitive behavior therapy program for panic disorder was developed based upon the results of the cognitive behavioral treatment with fifteen panic order patients.In the second part of this investigation, the effectiveness of the standardized cognitive behavior therapy for manic disorder patients were investigated from the viewpoints of pre- and post-treatment comparison, and the comparison with waiting list control group. Furthermore, effectiveness of exposure and cognitive restructuring, which are the major therapeutic components of the cognitive behavior therapy, was investigated using dismantling experimental design. As results, the standardized cognitive behavior therapy was effective to decrease many facets of symptoms of panic disorder. Furthermore, exposure was revealed to be effective to decrease agoraphobia, and cognitive restructuring was effective to decrease subjective anxiety.In the third part of this research, the effectiveness of the cognitive behavior therapy was investigated in terms of physiological change. The change of glucose metabolism in brain was investigated before and after the standardized cognitive behavior therapy using PET. After the cognitive behavioral treatment, significant decrease of glucose metabolism was found in hippocampus, cerebellum, pons, and putamen, which function as triggers of fear network, and the significant increase of glucose metabolism was found in brain regions which strengthen the ability of the medial prefrontal cortex to inhibit the amygdale. CBT program was an effective treatment for panic disorder with agoraphobia in terms of psychological and physiological change.The effectiveness of the cognitive behavior therapy for panic disorder patients were discussed from the clinical psychological points of view.