威胁预期的变化作为焦虑障碍基于暴露的心理治疗机制：来自605名患者的8,484次暴露练习的证据

Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients

——原载《临床心理科学》杂志2023年第11卷第2期——

< Clinical Psychological Science> 2023, 11 (2)

【摘要】个体对焦虑障碍症行为治疗的反应差异很大，这需要更好地了解潜在的过程。在这项研究中，我们检查了暴露期间威胁信念的违反和变化。从605名患有不同焦虑障碍的患者的8,484份标准化暴露记录中得出学习指标：预期违背是暴露前的威胁预期与威胁发生之间的不匹配，预期变化是暴露后原始预期和调整后预期之间的差异，预测误差学习率是预期违背转变为变化的程度。在整个治疗期间，高威胁预期但低发生率和调整后的预期表明通过暴露成功违反和改变了威胁信念。预期违背、变化和学习率在患者之间有很大差异。不是预期违背本身，而是更高的学习率和预期变化预示着更好的治疗结果。因此，成功的暴露需要违反预期以引起实际的预期变化，支持从预测错误中学习作为成功暴露治疗的跨诊断机制。

【关键词】暴露疗法，焦虑障碍，预测错误，预期违背，治疗结果，变化机制

[Abstract] Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From 8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy.

[Key words] exposure therapy, anxiety disorders, prediction error, expectancy violation, treatment outcome, mechanisms of change

论文原文：Andre Pittig, Ingmar Heinig, Hans-Ulrich Wittchen, et al. (2023). Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients. Clinical Psychological Science, Volume 11, Issue 2, Pages 199-217.

https://doi.org/10.1177/216770262211013

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