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공황장애 인지행동치료의 최신 지견

Recent Advances in Cognitive Behavioral Therapy for Panic Disorder

서호석|이상혁|이강수|서호준
대한불안의학회 (Korean Academy of Anxiety Disorders)|2016.04|대한불안의학회지 (Anxiety and Mood)|제12권 제1호|pp. 47-55

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참고문헌

키워드

인지행동치료공황장애Panic disorder단축형 인지행동치료인터넷 기반 인지행동치료Third-wave CBT마인드풀니스 기반 인지치료공황장애 약물치료 알고리듬Cognitive behavioral therapy (CBT)Brief CBTInternet based CBTMindfulness-based cognitive therapyAlgorithm project for panic disorder
주제분류정신과학

초록

30% of patients with panic disorder (PD) show treatment-resistant and chronic waxing and waning course. Therefore, adequate treatment strategies for PD by evidence based pharmacotherapy and combined cognitive behavioral therapy (CBT) are recommended. Regarding how and why CBT for PD works, three hypotheses include the cognitive theory, anxiety control theory, and behavioral theory were discussed. The recent findings that the altered activation in frontal lobe is normalized after CBT, suggest a reduction of an altered top-down fear processing in the neural correlates of CBT in PD. In order to improve accessibility to CBT, brief CBT and internet based CBT for PD were suggested. Despite limitations of sample sizes and study design, most of studies suggest that brief CBT is more effective than control conditions, and even as equally effective as standard CBT. The evidences suggest that internet based CBT may not be significantly different from face-to-face CBT in reducing anxiety. Several advances within the field of third-wave CBT for PD have led to the development of new techniques based on mindfulness, such as mindfulness-based cognitive therapy and acceptance and commitment therapy. Based on Korean algorithm project for panic disorder, especially the psychological education and cognitive reconstruction components were recommended in CBT with PD. (Anxiety and Mood 2016;12(1):47-55)

Abstract

30% of patients with panic disorder (PD) show treatment-resistant and chronic waxing and waning course. Therefore, adequate treatment strategies for PD by evidence based pharmacotherapy and combined cognitive behavioral therapy (CBT) are recommended. Regarding how and why CBT for PD works, three hypotheses include the cognitive theory, anxiety control theory, and behavioral theory were discussed. The recent findings that the altered activation in frontal lobe is normalized after CBT, suggest a reduction of an altered top-down fear processing in the neural correlates of CBT in PD. In order to improve accessibility to CBT, brief CBT and internet based CBT for PD were suggested. Despite limitations of sample sizes and study design, most of studies suggest that brief CBT is more effective than control conditions, and even as equally effective as standard CBT. The evidences suggest that internet based CBT may not be significantly different from face-to-face CBT in reducing anxiety. Several advances within the field of third-wave CBT for PD have led to the development of new techniques based on mindfulness, such as mindfulness-based cognitive therapy and acceptance and commitment therapy. Based on Korean algorithm project for panic disorder, especially the psychological education and cognitive reconstruction components were recommended in CBT with PD. (Anxiety and Mood 2016;12(1):47-55)

참고문헌 (52)

  1. Bandelow B, "Treatment-resistant panic disorder", CNS Spectr, 9, pp.725~739 (2004)
  2. Liebowitz MR, "Panic disorder as a chronic illness", J Clin Psychiatry, 58, pp.5~8 (1997)
  3. Toni C, "A prospective naturalistic study of 326 panic-agoraphobic patients treated with antidepressants", Pharmacopsychiatry, 33, pp.121~131 (2000)
  4. 서호석, "한국형 공황장애 약물치료 알고리듬 2008： 치료 불응성 공황장애 및 공존질환이 동반된 경우", 대한정신약물학회지, 20(1), pp.40~51 (2009), 대한정신약물학회
  5. 서호석, "공황장애의 근거중심적 약물치료", 대한의사협회지, 53(10), pp.913~921 (2010), 대한의사협회
  6. Bandelow B, "WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disoders, Zohar J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders-first revision", World J Biol Psychiatry, 9, pp.248~312 (2008)
  7. 최영희, "공황장애 환자에서 인지행동치료의 약물 감량 효과", 대한정신약물학회지, 14(4), pp.367~376 (2003), 대한정신약물학회
  8. Choi YH, "Comparison of the Effectiveness between Combined Therapy and Pharmacotherapy for Panic Disorder", Cognitive Behavior Therapy in Korea, 4, pp.73~83 (2004)
  9. Hunot V, "‘Third wave’ cognitive and behavioural therapies versus other psychological therapies for depression", Cochrane Database Syst Rev, 18, pp.10~ (2013)
  10. Executive Committee for Korean Medication Algorithm for Panic Disorder, "Korean medication algorithm project for panic disorder 2008" (2008), ML Communication
  11. Kazdin AE, "Mediators and mechanisms of change in psychotherapy research", Annu Rev Clin Psychol, 3, pp.1~27 (2007)
  12. Beck AT, "Anxiety disorders and phobias" (1985), NBB
  13. Clark DM, "A cognitive approach to panic", Behav Res Ther, 24, pp.461~470 (1986)
  14. Clark DM, "Anxiety disorders: why they persist and how to treat them", Behav Res Ther, 37(Suppl 1), pp.5~27 (1999)
  15. Austin DW, "The catastrophic misinterpretation model of panic disorder", Behav Res Ther, 39, pp.1277~1291 (2001)
  16. Bouton ME, "A modern learning theory perspective on the etiology of panic disorder", Psychol Rev, 108, pp.4~32 (2001)
  17. Russell JL, "Nonfearful panic disorder in neurology patients validated by lactate challenge", Am J Psychiatry, 148, pp.361~364 (1991)
  18. Barlow DH, "Anxiety and its disorders: The nature and treatment of anxiety and panic", pp.1988~ (1988), Guilford Press
  19. Casey LM, "The role of catastrophic misinterpretation of bodily sensations and panic self-efficacy in predicting panic severity", J Anxiety Disord, 18, pp.325~340 (2004)
  20. Mineka S, "Handbook of cognition, and emotion", pp.e747~e764 (1999)
  21. Borden JW, "Mechanisms of change in the treatment of panic", Cognitive Therapy and Research, pp.257~272 (1991)
  22. Bandura A, "Self-efficacy: The exercise of control" (1997), W. H. Freeman and Company
  23. Bandura A, "Negative self-efficacy and goal effects revisited", J Appl Psychol, 88, pp.87~99 (2003)
  24. Landon TM, "Cognitive-behavioral treatment for panic disorder: current status", J Psychiatr Pract, 10, pp.211~226 (2004)
  25. Smits JA, "Mechanism of change in cognitive-behavioral treatment of panic disorder: evidence for the fear of fear mediational hypothesis", J Consult Clin Psychol, 72, pp.646~652 (2004)
  26. Ost LG, "Cognitive behavior therapy vs exposure in vivo in the treatment of panic disorder with agoraphobia (corrected from agrophobia)", Behav Res Ther, 42, pp.1105~1127 (2004)
  27. Park JE, "Brain Imaging Provides Insight into the Neurobiology of Panic Disorder", Anxiety and Mood, 3, pp.91~96 (2007)
  28. Gorman JM, "Neuroanatomical hypothesis of panic disorder, revised", Am J Psychiatry, 157, pp.493~505 (2000)
  29. Prasko J, "The change of regional brain metabolism (18FDG PET) in panic disorder during the treatment with cognitive behavioral therapy or antidepressants", Neuro Endocrinology Letters, 25, pp.340~348 (2004)
  30. Sakai Y, "Changes in cerebral glucose utilization in patients with panic disorder treated with cognitive-behavioral therapy", Neuroimage, 33, pp.218~226 (2006)
  31. Kircher T, "Effect of cognitive-behavioral therapy on neural correlates of fear conditioning in panic disorder", Biological Psychiatry, 73, pp.93~101 (2013)
  32. Straube B, "Neural correlates of procedural variants in cognitive behavioral therapy: a randomized, controlled multicentre fMRI study", Psychotherapy and Psychosomatics, 83, pp.222~233 (2014)
  33. Anand A, "Brain imaging studies in mood and anxiety disorders: special emphasis on the amygdala", Ann N Y Acad Sci, 985, pp.370~388 (2003)
  34. Craske MG, "Brief cognitive-behavioral versus nondirective therapy for panic disorder", J Behav Ther Exp Psychiatry, 26, pp.113~120 (1995)
  35. Clark DM, "Brief cognitive therapy for panic disorder: a randomized controlled trial", J Consult Clin Psychol, 67, pp.583~589 (1999)
  36. Marchand A, "A randomized, controlled clinical trial of standard, group and brief cognitive-behavioral therapy for panic disorder with agoraphobia: a two-year followup", J Anxiety Disord, 23, pp.1139~1147 (2009)
  37. van Beek MH, "A brief cognitive-behavioral intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial", Depress Anxiety, 30, pp.670~678 (2013)
  38. Deacon B, "A pilot study of two-day cognitive-behavioral therapy for panic disorder", Behav Res Ther, 44, pp.807~817 (2006)
  39. Marchand A, "Treatment of panic in chest pain patients from emergency departments: efficacy of different interventions focusing on panic management", Gen Hosp Psychiatry, 34, pp.671~680 (2012)
  40. Lessard MJ, "Comparing two brief psychological interventions to usual care in panic disorder patients presenting to the emergency department with chest pain", Behav Cogn Psychother, 40, pp.129~147 (2012)
  41. 장은진, "공황장애에서 1회기 집단인지행동치료의 효능；예비 연구", 대한불안의학회지, 5(1), pp.36~41 (2009), 대한불안의학회
  42. Mewton L, "Current perspectives on Internet-delivered cognitive behavioral therapy for adults with anxiety and related disorders", Psychol Res Behav Manag, 7, pp.37~46 (2014)
  43. Olthuis JV, "Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults", Cochrane Database Syst Rev, 5, pp.CD011565~ (2015)
  44. Kabat-Zinn J, "Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders", Am J Psychiatry, 149, pp.936~943 (1992)
  45. Segal ZV, "Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse" (2002), Guilford Press
  46. Linehan M, "Cognitive-behavioral treatment of borderline personality disorder" (1993), Guilford Press
  47. Hayes SC, "Acceptance and commitment therapy : an experiential approach to behavior change" (1999), Guilford Press
  48. Kim B, "Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder", J Anxiety Disord, 24, pp.590~595 (2010)
  49. Kim YW, "Effectiveness of mindfulness-based cognitive therapy as an adjuvant to pharmacotherapy in patients with panic disorder or generalized anxiety disorder", Depress and Anxiety, 26, pp.601~606 (2009)
  50. Min Kuk Kim, "Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder", PSYCHIATRY INVESTIGATION, 13(2), pp.196~202 (2016), 대한신경정신의학회[DOI]
  51. John PF, "The Mindfulness and Acceptance Workbook for Anxiety" (2007), New Harbinger Publications
  52. Lee SH, "Study Group of Korean Medication Algorithm Project for Panic Disorder 2008. Development of the medication algorithm for panic disorder(3): Cognitive behavioral therapy", Anxiety and Mood, 4, pp.28~33 (2008)

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