日常生活中的暴露追踪：基于暴露的焦虑障碍心理治疗后生态评估的社会和身体活动的改善

Exposure traced in daily life: improvements in ecologically assessed social and physical activity following exposure-based psychotherapy for anxiety disorders

<Journal of Anxiety Disorders>Volume 101: 102792, 2024

【摘要】背景：尽管针对焦虑障碍的基于暴露的认知行为疗法经常被证明是有效的，但只有很少的研究检验它是否可以改善日常行为结果，例如社交和体力活动。方法：126名参与者（85名患有恐惧症、广场恐惧症、社交焦虑障碍或特定恐惧症的患者，以及41名没有精神障碍的对照者）完成了基于智能手机的动态评分（活动、社交互动、情绪、身体症状）和基于运动传感器的运动指数基线、基于暴露的治疗期间和之后的体力活动（步数、移动时间、代谢活动）。结果：在治疗之前，与健康对照组相比，患者的情绪和体力活动均减少。在治疗过程中，情绪评分、与陌生人的互动和体力活动指数均有所改善，而报告的身体症状则有所减少。原发性恐惧症/广场恐惧症和社交焦虑障碍患者的总体结果没有差异。基线时较高的抑郁评分与报告的症状和情绪评分的较大变化相关，但体力活动的变化较小。结论：基于暴露的治疗可以增加体力活动，更频繁地与陌生人互动，并改善日常情绪。目前的方法提供了客观和精细分级的过程和结果测量，可能有助于进一步改善治疗并可能减少复发。

【关键词】暴露疗法；焦虑障碍；生态瞬时评估；心理治疗的有效性；体力活动；运动活动

[Abstract] Background: Although exposure-based cognitive-behavioral therapy for anxiety disorders has frequently been proven effective, only few studies examined whether it improves everyday behavioral outcomes such as social and physical activity. Methods: 126 participants (85 patients with panic disorder, agoraphobia, social anxiety disorder, or specific phobias, and 41 controls without mental disorders) completed smartphone-based ambulatory ratings (activities, social interactions, mood, physical symptoms) and motion sensor-based indices of physical activity (steps, time spent moving, metabolic activity) at baseline, during, and after exposure-based treatment. Results: Prior to treatment, patients showed reduced mood and physical activity relative to healthy controls. Over the course of therapy, mood ratings, interactions with strangers and indices of physical activity improved, while reported physical symptoms decreased. Overall results did not differ between patients with primary panic disorder/agoraphobia and social anxiety disorder. Higher depression scores at baseline were associated with larger changes in reported symptoms and mood ratings, but smaller changes in physical activity. Conclusions: Exposure-based treatment initiates increased physical activity, more frequent interaction with strangers, and improvements in everyday mood. The current approach provides objective and fine-graded process and outcome measures that may help to further improve treatments and possibly reduce relapse.

[Key words] Exposure therapy; Anxiety disorders; Ecological momentary assessment; Effectiveness of psychotherapy; Physical activity; Motor activity

论文原文：Ingmar Heinig, Martin Wei, Alfons O. Hamm, Grit Hein, Maike Hollandt, Jürgen Hoyer, Philipp Kanske, Jan Richter, Hans-Ulrich Wittchen, Andre Pittig (2024). Exposure traced in daily life: improvements in ecologically assessed social and physical activity following exposure-based psychotherapy for anxiety disorders. Journal of Anxiety Disorders. Volume 101: 102792 January 2024.

https://doi.org/10.1016/j.janxdis.2023.102792

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