陪同式系统脱敏治疗社交恐怖症的对照研究

目的： 探索提高治疗社交恐怖症疗效的方法。方法： 对首次住院诊断为社交恐怖症的病例， 采用随机的方法分入陪同式系统脱敏疗法组和一般系统脱敏疗法组进行８周对照治疗研究，随访一年，并用恐怖自评表对治疗前后及随访进行评定。结果： 治疗前后比较， 两组恐怖自评分均有显著下降（ｐ＜ ０．０１）， 治疗结束与随访时两组间评分均有显著性差异（ｐ＜ ０．０５）， 两组间治愈率有显著性差异（分别为６３．６４％ 及２７．７８％ ， ｐ＜ ０．０５）。结论： 两种方法对社交恐怖症治疗均有效， 但陪同式系统脱敏疗法治疗社交恐怖症的疗效更为明显。     

冲击疗法治疗5例恐怖症

冲击疗法治疗５例恐怖症徐州市精神病防治院李学钧，魏贤王冲击疗法与系统脱敏疗法相反，治疗者使用对病人来说能引起最强烈的恐惧情绪的刺激“冲击”病员，让患者感到恐怖的事物对患者没有真正的威协，从而达到消除恐惧情绪的目的。据报道治疗恐怖症疗效显著，笔者运用此...     

系统脱敏与合并阿普唑仑治疗恐怖症对照研究

将符合ＣＣＭＤ－２－Ｒ诊断标准的３１例恐怖症病人,随机对１６例在阿普唑仑治疗的基础上联合系统脱敏治疗,另１５例单纯用系统脱敏治疗。发现两组疗效无显著性差异。合并阿普唑仑可以帮助降低焦虑,提高对系统脱敏治疗的依从性,但不能提高疗效。     

系统脱敏法治疗性交恐怖症Ⅰ例报告

性交恐怖症 ,是临床比较少见的一种心理障碍。本文报告一例采用系统脱敏法 ,取得了良好疗效。1　病例患者女 ,2 8岁 ,已婚 ,因性交困难就诊。患者于2年前结婚 ,初次性交因处女膜破裂出血“疼痛难忍”而中断 ,从此 ,对性交产生恐惧心理 ,每次都很紧张 ,四肢发硬 ,呼吸困难 ,甚至惊恐发作。久而久之 ,丈夫的性欲大大减退。现在迫于外界的压力 ,为了生孩子而求医 ,妇科检查未见阴道痉挛、炎症、畸形和其它异常 (妇检时惊恐万状 )。患者从小娇生惯养 ,怕苦怕痛 ,洗头多挠几下头皮都无法忍受。从谈话中得知 ,性交困难主要不是因疼痛 ,而是恐惧 ,…     

社交恐怖症 与对人恐怖症

社交恐怖症与对人恐怖症北京回龙观医院王锦霞，王向群在西方国家尤其是美国所见到的社交恐怖症（Ｓｏｃｉａｌｐｈｏｂｉａ）与东方国家（中国、日本、韩国等）常见的对人恐怖症是不是同一心理障碍的不同命名呢？在东、西方不同的文化背景下，其诊断、治疗有何不同？二者...     

森田疗法治疗1例社交恐怖症

1病例男，23岁．大学文化．未婚。主因见人紧张．回避社交场合而入院治疗。该患从小与祖父母生活在一起，7岁回到父母身边．个性孤僻、要强．从小学到大学成绩一直很好,但与同学、老帅关系较疏远。既往健康，无精神病史。患者于高三时，团按自己的方法学习,未完成作业，当众被体罚．加上同学取笑,此后便对同学、老师反感,不愿与人交往，逐渐发展到上课不敢看老帅,不敢着黑板,异常紧张、很少参加集体活动。大学毕业后分配工作，害怕与同事、领导交往，回避人多场面。自己阅读许多有关人生哲理方面的书，也不知如何是好，到处就医均未见效,特…     

社交恐怖症心理咨询一例

本案例以某大三学生的社交障碍为切入点,通过运用系统脱敏疗法,使其消除了社交恐怖心理,现报告如下。 1一般资料 求助者,女,23岁,某大学大三学生。求助者衣着整洁朴素,年貌相符,身材纤瘦。进入咨询室时步态正常,但神情低落,紧张焦虑。就坐后不敢正视咨询师,比较拘谨,目光中有些疑惑。但接触合作,对答切题,能描述自己的问题,     

社交恐怖症心理咨询一例

<正>本案例以某大三学生的社交障碍为切入点,通过运用系统脱敏疗法,使其消除了社交恐怖心理,现报告如下。1一般资料求助者,女,23岁,某大学大三学生。求助者衣着整洁朴素,年貌相符,身材纤瘦。进入咨询室时步态正常,但神情低落,紧张焦虑。就坐后不敢正视咨询师,比较拘谨,目光中有些疑惑。但接触合作,对答切题,能描述自己的问题,自知     

想象系统脱敏治疗恐怖症1例

男,22岁,未婚,大学一年级学生。对那种清理咽部分泌物的咳漱声,及随之而来的强有力的擤鼻涕声,有特殊的敏感。听到这种声音就烦燥至极,非常紧张,并出现胸闷,心悸,出汗……等许多症状,以致不能正常的工作与学习。与患者同班的一位同学因患慢性咽炎及鼻炎,每节课都要多次发出这种一连串的声音,而使患者无法听课。他自己叙述:“我一听到这种一连串的声音,就受不了,好象是在受煎熬,在课堂上我跟本不知道老师在讲什么,我巴不得赶快离     

认知领悟疗法治疗恐怖症疗效观察

恐怖症是一种常见神经症，在我国神经症专科门诊中占6．7％[1]。迄今病因不明，疗效不甚满意。本文应用钟氏认知领悟疗法[2]治疗22例恐怖症．取得了一定的疗效（痊愈27．27％，显著进步45％，进步13．64％），治疗后SCL－90焦虑、恐怖、偏执、抑郁和躯体化因于分明显改善。1对象和方法1．1对象来自1994～1997年我院恐怖症病人·人组标准：符合CCMD—Ⅱ—R恐怖症诊断标准；无躯体疾病和其它精神障碍；无酒精依赖和药物滥用；至少近两周未采用心理和药物治疗。共22例．男18冽．女4例；年龄17～48岁．平均274土62岁；病期回～11年·平均5．…     

Internet‐based treatment for social phobia: a randomized controlled trial

In this study conducted in the French‐speaking part of Switzerland, 52 individuals with social phobia were randomly assigned either to an Internet‐based cognitive–behavioral treatment with minimal contact with therapists via e‐mail or to a waiting‐list control group. Significant differences between the two groups were found at posttreatment on all primary outcome measures (social anxiety measures) and on two of the secondary outcome measures (general symptomatology, therapy goal attainment). On average, within‐groups effect sizes were large for the primary outcomes (Cohen's d=0.82) and for secondary outcomes (Cohen's d=1.04). Moreover, subjects in the treatment group fulfilled the criteria of clinically significant improvement significantly more often than subjects in the control group on all measured dimensions (58% vs. 20%). Users' acceptance of the program was high. The results from the present study lend further support to the hypothesis that Internet‐delivered interventions with minimal therapist contact are a promising treatment approach to social phobia. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–15, 2009.     

A model of the development and maintenance of generalized social phobia

Many factors have been associated with the development and maintenance of generalized social phobia (GSP); however, the ways in which these factors interact with one another to produce and maintain GSP remains unclear. The current paper proposes that Reinforcement Sensitivity Theory (RST) can be used to integrate a wide range of factors into a unified and theoretically-driven model of GSP. The paper begins by briefly summarizing research on genetic, temperamental, environmental, and cognitive factors associated with GSP. The next section of the paper provides an overview of RST. A model of the development and maintenance of GSP is then presented. The proposed model is unique because it: (a) integrates a wide range of factors into a unified model of GSP, (b) incorporates recent updates to RST, (c) provides a potential explanation for the differences observed among social phobia subtypes, (d) considers the role of general stressors in the development of GSP, (e) provides a biologically-based framework for understanding the cognitive biases seen in GSP, and (f) predicts the conditions under which these cognitive biases are most likely to emerge. Clinical implications and future directions for research are discussed.     

An event-related potential study on exposure therapy for patients suffering from spider phobia

The present event-related potential (ERP) study investigated electrocortical changes related to cognitive behavior therapy (CBT) in spider phobic females. Forty-five patients and twenty non-phobic women were presented with phobia-relevant, generally fear-inducing, disgust-inducing and affectively neutral pictures in a first EEG session. Phobic patients were randomly assigned to either a therapy (TG) or a waiting-list (WG) group. EEG measurement was repeated after CBT or a waiting period. ERPs were extracted in the time windows 340-500 ms (P300), 550-770 ms (late positive potential (LPP), early LPP) and 800-1500 ms (late LPP). Relative to controls, untreated phobics showed enhanced amplitudes of P300 and early LPP in response to spider pictures. This most likely reflects the emotional significance of the phobic stimulus, which automatically draws attention. The therapy effect consisted of a significant enhancement of late LPP amplitudes in response to spider pictures. Results are discussed in terms of reduced attentional avoidance.     

Aspirin desensitization in the treatment of antiphospholipid syndrome during pregnancy in ASA-sensitive patients

PROBLEM: Antiphospholipid syndrome (APS) is associated with thrombosis and poor pregnancy outcome in the presence of antiphospholipid antibodies (aPL). Patients with aPL have a high risk of foetal loss. However, with low-dose aspirin (acetylsalicylic acid; ASA) in combination with subcutaneous heparin, the chances of full-term delivery increase. Nevertheless, ASA treatment is avoided in pregnant, ASA-sensitive women with APS. METHODS: Rapid oral challenge-desensitization to ASA was performed in four pregnant women with a history of APS and aspirin sensitivity. In three patients, desensitization was performed during pregnancy and before the next pregnancy in the fourth. Desensitization was carried out in the ICU using increasing doses of aspirin (0.1-125 mg) over a 24-hr period. RESULTS: Successful ASA desensitization was achieved in all the patients. No severe side effects occurred during the desensitization test. Only one patient required a small oral dose of antihistamines. CONCLUSIONS: Aspirin desensitization may be a safe alternative even during pregnancy if carefully monitored and permit patients with APS to receive treatment with ASA. This would constitute a new indication in pregnant women with APS and ASA sensitivity.     

A family study of co-morbidity between generalized social phobia and generalized anxiety disorder in a non-clinic sample

BACKGROUND: High rates of co-morbidity between Generalized Social Phobia (GSP) and Generalized Anxiety Disorder (GAD) have been documented. The reason for this is unclear. Family studies are one means of clarifying the nature of co-morbidity between two disorders. METHODS: Six models of co-morbidity between GSP and GAD were investigated in a family aggregation study of 403 first-degree relatives of non-clinical probands: 37 with GSP, 22 with GAD, 15 with co-morbid GSP/GAD, and 41 controls with no history of GSP or GAD. Psychiatric data were collected for probands and relatives. Mixed methods (direct and family history interviews) were utilised. RESULTS: Primary contrasts (against controls) found an increased rate of pure GSP in the relatives of both GSP probands and co-morbid GSP/GAD probands, and found relatives of co-morbid GSP/GAD probands to have an increased rate of both pure GAD and co-morbid GSP/GAD. Secondary contrasts found (i) increased GSP in the relatives of GSP only probands compared to the relatives of GAD only probands; and (ii) increased GAD in the relatives of co-morbid GSP/GAD probands compared to the relatives of GSP only probands. LIMITATIONS: The study did not directly interview all relatives, although the reliability of family history data was assessed. The study was based on an all-female proband sample. The implications of both these limitations are discussed. CONCLUSIONS: The results were most consistent with a co-morbidity model indicating independent familial transmission of GSP and GAD. This has clinical implications for the treatment of patients with both disorders.     

Interpretation of ambiguous social scenarios in social phobia and depression: evidence from event-related brain potentials

In the current study, event-related potentials (ERPs) and behavioral responses were measured in individuals meeting diagnostic criteria for social phobia, depression, their combination, or neither in order to examine the unique and combined effects of social phobia and depression on the interpretation of ambiguous social scenarios. ERPs revealed a lack of positive interpretation bias and some suggestion of a negative bias in the semantic expectancy N4 component across all clinical groups. Furthermore, socially phobic and comorbid individuals showed reductions in baseline attention allocation to the task, as indexed by P6 amplitude. RT and accuracy likewise revealed a lack of positive interpretation bias across disordered groups. When considered on a continuum across all samples, social phobia and depression symptoms were related to the N4 interpretation bias effect whereas P6 amplitude reduction and RT interpretation bias appeared uniquely associated with social phobia.     

Task-dependent neural correlates of the processing of verbal threat-related stimuli in social phobia

The neural basis of abnormal processing of phobia-related linguistic cues in individuals suffering from social phobia is unknown, particularly in respect to different task conditions. Using event-related functional magnetic resonance imaging, this study investigated brain activation to phobia-related and phobia-unrelated words in 19 socially phobic patients and 18 healthy control subjects (HC) while subjects had to attend either to social meaning or to grammatical category of words (direct or indirect task). During the indirect task, patients, compared to HC, showed an increased activation of the amygdala and orbitofrontal cortex (OFC) in response to phobia-related vs. phobia-unrelated words. Activation of the insula was positively correlated with patients’ symptom severity during the direct task. The results suggest a specific role of the amygdala and OFC during the processing of verbal phobia-relevant distracting information. In contrast, insula activation seems to be more important for direct processing of disorder-related words, especially in more severe cases of social phobia.