1例研究生惊恐障碍的元认知心理干预实验研究

目的探讨惊恐障碍的心理机制及其干预方法,为惊恐障碍的心理干预提供临床借鉴。方法采用单被试多基线实验设计,运用元认知心理干预技术对来访者进行临床干预。结果干预前来访者症状自评量表(SCL-90)所有因子均显示异常,其中抑郁3.38,焦虑3.30,敌对3.67,汉密尔顿焦虑量表(HAMA)得分为36分。干预结束后SCL-90各项因子分均达到正常水平,HAMA得分为6分,基线指标稳定,惊恐发作次数减少,焦虑水平降低,社会适应性增强。结论实验证明元认知心理干预技术是治疗惊恐障碍的有效心理干预方法,值得推广。     

大学生广泛性焦虑障碍的元认知心理干预效果实验研究

目的 探讨广泛性焦虑障碍的心理机制及其干预方法,为大学生的广泛性焦虑障碍的治疗提供借鉴.方法 在小样本多基线实验设计中,运用元认知干预技术对1例广泛性焦虑障碍的来访者进行干预.结果 干预前来访者的症状自评量表(SCL-90)中某些因子分显示异常,如焦虑4.0、恐怖4.14等,汉密尔顿焦虑量表(HAMA)得分为34分.在没有使用任何辅助药物的情况下,通过11次咨询后SCL-90各项因子分均达到正常水平,焦虑1.6、恐怖1.86等,HAMA得分为14分,来访者在学校能够正常生活.结论 此实验初步证明了,元认知干预技术对广泛性焦虑障碍的治疗是很有效的心理干预方法.     

1例大学生学校恐惧的元认知心理干预

目的探讨大学生学校恐惧的心理机制及其干预方法,为学校恐惧的临床治疗提供借鉴。方法采用观察法、访谈法、认知疗法及行为疗法中的放松训练,并结合元认知心理干预技术中情感组织者技术对一名患有学校恐惧的来访者进行个案实验研究。结果治疗前SCL-90症状自评量表中某些因子分显示异常,如人际关系敏感3.11、抑郁3.15、敌对3.33等。在没有使用任何辅助药物的情况下,通过7天共6次放松训练,治疗后SCL-90症状自评量表中各项因子分均达到正常水平,如人际关系敏感1.67、抑郁1.92、敌对1.83等。来访者可回到学校正常生活。结论元认知心理干预技术治疗学校恐惧临床效果显著,适合于普遍推广和使用。     

1例抑郁症的元认知心理干预

目的探讨大学生抑郁症的心理机制及其干预方法,为抑郁症的临床治疗提供借鉴。方法采用观察法、访谈法、认知疗法及行为疗法中的放松训练,并结合元认知干预技术中情感组织者技术对1名患有抑郁症的来访者进行个案实验研究。结果治疗前用抑郁自评量表（SDS）对来访者进行测试为68分,属于中度抑郁。在没有使用任何辅助药物的情况下,通过为期5天的5次放松训练,治疗后其抑郁自评量表（SDS）测试为46分,达到正常值,来访者的抑郁症状已经基本消除。结论元认知干预技术治疗抑郁症效果显著,适合于推广和使用。     

1例初中生惊恐障碍的诊断与治疗

目的以1例惊恐障碍的初中生为例探讨条件性情绪干预法对惊恐障碍干预的有效性,为惊恐障碍的心理干预提供临床借鉴。方法在单个被试的情况下,采用多基线实验设计,运用条件性情绪干预法对来访者进行临床干预。同时用汉密顿焦虑量表（HAMA）、焦虑自评量表（SAS）、症状自评量表（SCL-90）对干预过程中各项指标的变化进行评估。结果干预后来访者的各项指标稳定,惊恐发作次数减少,焦虑水平降低,社会适应性增强。结论运用条件性情绪干预法可对惊恐障碍进行有效干预,降低惊恐焦虑水平,长期训练有彻底治愈的可能。     

大学生强迫行为的临床技术干预与效果分析

目的探讨大学生强迫行为的心理机制及其干预方法,为强迫症的临床治疗提供借鉴。方法采用多基线个案实验研究设计,采用观察法、访谈法、认知疗法及行为疗法中的放松训练,并结合元认知行为干预技术中情感组织者技术对一名患有强迫症的来访者进行个案实验研究。结果治疗前耶鲁布朗量表评分为28分。在没有使用任何辅助药物的情况下,通过6天共6次放松训练,治疗后评分为8分,病人强迫行为已经基本消除。结论元认知行为干预技术治疗强迫行为临床效果显著,适合于普遍推广和使用。     

运用心理技术治愈社交恐惧的个案研究

目的探讨用心理技术治疗社交恐惧障碍的方法及过程。方法依据医学鉴定结果,症状自评量表（SCL-90）测量结果以及来访者典型行为表现诊断为社交恐惧障碍;根据来访者的实际情况,采用观察法、谈话法、认知疗法、放松训练等心理技术,制定详细地干预计划并对其进行心理咨询与治疗。结果治疗后来访者的焦虑、人际敏感、抑郁等消极情绪有了显著改善（P〈0.01）,社交恐惧障碍得到了有效控制,最终治愈。结论运用认知疗法、放松训练等心理技术对社交恐惧障碍进行治疗是有效的。     

大学生演讲紧张的元认知心理干预

目的探讨大学生演讲紧张的心理机制及其干预方法,为演讲紧张的临床治疗提供借鉴。方法采用观察法、访谈法、认知疗法及行为疗法中的放松训练,并结合元认知心理干预技术中情感组织者技术对演讲紧张的来访者进行实验研究。结果治疗前交流恐惧自陈量表(PRCA一24)评分为80分,通过7天共6次放松训练,治疗后评分为47分。演讲者信心自评量表(PRCS)前测26分,后测6分。来访者成功地在其所在班级进行了演讲。结论元认知心理干预技术治疗演讲紧张临床效果显著,适于推广和使用。     

1例由社交恐惧引起的学习倦怠的个案研究

目的通过对1名社交恐惧障碍来访者的诊断与干预,探讨用心理技术治疗社交恐惧障碍的同时解决学生学习倦怠问题。方法来访者经医学鉴定、症状自评量表（SCL-90）测量结果以及典型行为表现诊断为社交恐惧障碍。采用观察法、谈话法、认知疗法、放松训练等心理技术对其进行心理咨询与治疗,消除社交恐惧,同时解决学习倦怠问题。结果治疗后社交恐惧症状得到有效控制（P〈0.01）,学习倦怠得以解决。结论运用认知疗法、放松训练等心理技术对社交恐惧障碍治疗是有效并可以帮助学生克服学习倦怠,恢复正常的学习生活。     

中医医院护士心理健康状况调查分析与对策

目的 旨在了解我院护士心理健康状况,探讨其预防及调节方法.方法 采用SCL-90症状自评量表对我院181名在职护士的心理健康状况在心理干预前后进行调查研究.结果 心理干预前SCL-90症状自评量表调查显示,我院护士的SCL-90总分、躯体化、抑郁、焦虑、敌对、强迫5项因子分高于中国常模,两者存在着显著性差异(P＜0.05),阳性项目数、其余因子分与中国常模比较无显著性差异(P＞0.05),心理干预后SCL-90症状自评量表测查结果与第一次比较:抑郁、焦虑,敌对3项因子分明显降低,两者有显著性差异,P＜0.05.结论 护士的心理健康状况不佳应引起关注,相应心理干预措施可以提高其心理健康水平.     

舍曲林合并认知行为疗法治疗惊恐障碍14例

目的 :观察舍曲林合并认知行为疗法对惊恐障碍的治疗效果。方法 :对符合CCMD -Ⅱ -R诊断标准的 14例惊恐障碍患者给每晨饭后 5 0毫克的舍曲林连续治疗 6个月 ,同时给予认知行为治疗 ,按临床疗效判定标准定期评定。结果 :一个月显效者占 2 1 4% ,好转占 64 3 % ,无效占 14 3 % ;三个月显效者占71 4% ,好转占 2 8 6% ,半年时显效者占 85 7% ,好转者占 14 3 %。 2 1 4%患者在治疗中出现过轻微的副作用 ,随时间延长而消失。结论 :舍曲林合并认知行为治疗能明显缩短疗程 ,减少医疗开支 ,安全性高 ,依从性好     

帕罗西汀合并认知行为疗法治疗惊恐障碍对照研究

目的观察帕罗西汀合并认知行为疗法对惊恐障碍的治疗效果。方法将符合ICD-10诊断标准的40例惊恐障碍患者分为治疗组和对照组,治疗组给予帕罗西汀30~40mg/d合并认知行为治疗,对照组只给予帕罗西汀30~40mg/d治疗,应用临床标准疗效及汉密尔顿焦虑量表（HAMA）、临床疗效总评量表（CGI-SI）及副反应量表（TESS）评定疗效和不良反应。观察12周。结果在治疗第4、8和12周末时,治疗组疗效均优于对照组,具有显著性统计学意义（P〈0.05）。两组不良反应轻微,无需处理。结论帕罗西汀合并认知行为疗法治疗惊恐障碍效果优于单纯用药物治疗。     

Neurobiological correlates of panic disorder and agoraphobia

Panic Disorder and agoraphobia offer considerable diagnostic and management challenges, particularly in general practice. We describe a typical case of panic disorder in a young adult. The recent advances in our understanding of brain functions can be used to explain to a certain extent the biologic basis of panic disorder. A hypothetical model integrating current views on panic disorder and agoraphobia has been proposed. The management principles including the role of cognitive therapy and pharmacotherapy have been discussed.     

A comparison of alprazolam and behavior therapy in treatment of panic disorder

The results of a clinical outcome study (N = 57) comparing behavior therapy directed at panic disorder (panic control treatment [PCT]) with alprazolam were reported. These conditions were compared with a medication placebo and a waiting-list control group. Patterns of results on measures of panic attacks, generalized anxiety, and global clinical ratings reveal that PCT was significantly more effective than placebo and waiting-list conditions on most measures. The alprazolam group differed significantly from neither PCT nor placebo. The percentage of clients completing the study who were free of panic attacks following PCT was 87%, compared with 50% for alprazolam, 36% for placebo, and 33% for the waiting-list group. Since alprazolam may work more quickly than PCT but may also interfere with the effects of behavioral treatment, these data suggest a series of studies on the feasibility of integrating these treatments and on the precise patterns and mechanisms of action of various successful treatment approaches to panic disorder.     

Locus of control orientation in panic disorder and the differential effects of treatment

BACKGROUND: In this study the effects of treatment with cognitive therapy, antidepressants or pill-placebo on the locus of control orientation in panic disorder patients were analysed, as well as the relation of this panic locus of control with panic frequency and cognitive measures of panic. METHODS: A Multidimensional Anxiety Locus of Control scale (MALC) was developed and completed with other measures (ACQ and BSQ) before and after treatment. Patients also kept a panic diary. RESULTS: Four subscales were derived from the MALC: one Internal, and three external (a Chance, a Medication, and a Therapist) locus of anxiety control orientation scales. Cognitive therapy was superior over pill-placebo on most outcome measures whereas antidepressants were only superior in reducing the number of panic attacks. Treatment with cognitive therapy resulted in an increase of 'internal' anxiety control orientation and a decrease of 'chance' and 'medication' orientation, in comparison with antidepressant therapy. The residualized gain scores on the MALC subscales correlated with clinical improvement in subjects treated with cognitive therapy only. CONCLUSIONS: Results suggest that the locus of control orientation is important in evaluating the differential effects of treatments in panic disorder. A differential effect on panic locus of control in favor of cognitive therapy in comparison to medication was found.     

认知行为疗法并帕罗西汀治疗惊恐障碍疗效分析

目的评价认知行为疗法并帕罗西汀治疗惊恐障碍的治疗效果。方法将符合中国精神障碍分类与诊断标准的69例惊恐障碍患者随机分为研究组（n=37）和对照组（n=32）。研究组给予认知行为并帕罗西汀治疗,对照组单用帕罗西汀治疗,疗程12周,在入组前和治疗2、4、8、12周末应用临床疗效标准和汉密尔顿焦虑量表（HAMA）评定疗效。完成该研究的60名参与者的数据纳入了结果分析。结果汉密顿焦虑量表总分研究组治疗2周末较治疗前有极显著性下降（t=5.56,P〈0.01）;对照组治疗4周末较治疗前有极显著性下降（t=4.27,P〈0.01）;治疗后2、4、8、12周末研究组疗效显著优于对照组。结论认知行为疗法并帕罗西汀治疗惊恐障碍效果优于单用帕罗西汀治疗。     

Relevance of assessment of cognitions during panic attacks in the treatment of panic disorder

BACKGROUND: In this paper the effects of cognitive therapy on the belief in causal catastrophic misinterpretations (CCMs) of bodily sensations in panic disorder patients were studied. METHODS: CCMs were formulated at the start of treatment and assessed at every treatment session for credibility during panic attacks and during that session. The relation between the belief in CCMs and other measures of panic was also studied. Sixty-six patients rated their belief in 1-3 CCMs during treatment with cognitive therapy. They also filled in questionnaires (ACQ and BSQ) at the start and end of treatment and kept a panic diary. RESULTS: The belief in CCMs diminished significantly in the course of treatment. A significant correlation between panic frequency and belief in CCMs during panic attacks, but not during treatment sessions, was found. Relations between improvement in panic frequency, ACQ- and BSQ-scores on the one hand and belief in CCMs on the other, also revealed significant correlations with belief ratings during panic attacks only. CONCLUSIONS: Especially ratings of belief during panic attacks are important in assessing the outcome of cognitive therapy in panic disorder. This measure can be considered as a severity measure. Belief in CCMs during treatment sessions seems to have little clinical significance.     

Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions

This article describes a broad-spectrum, computer-aided self-help clinic that raised the throughput of anxious/depressed patients per clinician and lowered per-patient time with a clinician without impairing effectiveness. Many sufferers improved by using one of four computer-aided systems of cognitive behavior therapy (CBT) self-help for phobia/panic, depression, obsessive-compulsive disorder, and general anxiety. The systems are accessible at home, two by phone and two by the Web. Initial brief screening by a clinician can be done by phone, and if patients get stuck they can obtain brief live advice from a therapist on a phone helpline. Such clinician-extender systems offer hope for enhancing the convenience and confidentiality of guided self-help, reducing the per-patient cost of CBT, and lessening stigma. The case examples illustrate the clinical process and outcomes of the computer-aided system.     

EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measures (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention-placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (eta2 = .00-.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive-behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder.