怎样治疗恐惧强迫症

如何治疗恐惧强迫症配图，仅供参考

Treatment of Social Anxiety Disorder
As with most anxiety disorders,social anxiety disorder responds well to pharmacologic treatment and psychotherapy. The aim of both types of interventions is to reduce social fears so that the feared situations are no longer avoided or that they are associated with minimal discomfort. The following sections review various therapeutic interventions.
# Pharmacotherapy
Several different classes of medication have been shown to be effective in the treatment of social anxiety disorder. The primary drug classes include the monoamine oxidase inhibitors (MAOIs),benzodiazepines,and more recently,selective serotonin reuptake inhibitors (SSRIs) ).
MAOIs
These medications block monoamine oxidase,an enzyme that breaks down monoamines. Monoamines are one of the major classes of signal-transmitting chemicals (i.e.,neurotransmitters) in the brain and are thought to play a role in mood and anxiety disorders. MAOIs have been shown to be efficacious in the treatment of anxiety disorders in several well-designed studies ). However,these medications require a special diet that restricts the ingestion of the amino acid tyramine (which is contained in cheese,red wine,some imported beers,and yogurt) to avoid a potentially deadly episode of high blood pressure (i.e.,a hypertensive crisis). Because of this potentially serious side effect,most physicians no longer prescribe these medications.
Benzodiazepines
These sedative medications are also effective in the treatment of social anxiety disorder. For example,alprazolam and clonazepam are both well tolerated and have shown promise in the treatment of social anxiety ). However,as discussed more fully below,their use in patients with comorbid social anxiety and alcohol problems may not be advisable.
SSRIs
These agents,which affect a brain signaling system using the brain chemical serotonin,are perhaps the best tolerated and most carefully studied pharmacologic treatment for social anxiety disorder. Although several of these medications have shown some efficacy,paroxetine (Paxil?) is the only medication currently on the market that has been approved by the U.S. Food and Drug Administration for the treatment of social anxiety disorder. At least three clinical trials have shown this agent to be significantly more effective than an inactive substance (i.e.,a placebo) in reducing social anxiety and alleviating the problems associated with social anxiety disorder ). Based on these results,SSRIs have been proposed as the first line of treatment for social anxiety disorder ).
# Psychotherapy
Psychological treatment of people with social anxiety disorder has used various approaches that focus on role playing,coping skills training,exposure to feared situations,and changing the patients’ erroneous negative beliefs about how people perceive them ). Because social anxiety disorder involves excessive fear of humiliation and criticism,cognitive behavioral therapies (CBT) have proved to be successful for this disorder and,like medications,to be more effective than control conditions ). CBT approaches are based on the assumption that human behavior is largely learned and that learning processes therefore can be used to change problem behaviors. CBT is not one uniform type of therapy but can be classified into four different categories ):
Exposure therapy is a technique in which patients are given skills to alleviate anxiety and then are encouraged to expose themselves to an anxiety-provoking situation in an attempt to extinguish the anxiety. Exposure to anxiety-inducing situations is considered an essential component of therapy because many patients,if left on their own,would avoid such situations altogether,thereby restricting their lifestyle.
Cognitive restructuring is a model in which clients are taught to identify thoughts that provoke anxiety and to think in a less biased,anxiety-provoking way. Challenging erroneous beliefs with video feedback or feedback from group members is an important component of cognitive therapy.
Relaxation training is a method of decreasing anxiety by controlling the amount of physical tension experienced in a stressful situation. Relaxation training alone,however,is not usually as successful as cognitive restructuring or exposure therapy.
Social skills training teaches patients how to improve their behavioral skills in social interactions. However,not all people with social anxiety disorder have deficits in social skills. Therefore,social skills training alone would not benefit all clients with the disorder.
Most CBT for social anxiety disorder involves a combination of these different approaches. Regardless of which specific CBT measures are evaluated,it is important to recognize that non-pharmacological treatments for social anxiety disorder are effective ) and generally work as well as medication. In addition,some findings indicate that despite a slower onset of improvement compared with pharmacotherapy,the beneficial effect of psychotherapy may be more enduring ).
Only a few studies have evaluated treatment of people with comorbid social anxiety disorder and AUDs,but based on research in individuals with social anxiety disorder alone,some treatments would be expected to be efficacious. Of the pharmacological treatments,SSRIs may be most appropriate for clients with both types of disorders. These medications are safe,are not addictive,and do not interact with alcohol in the brain. In addition,accumulating evidence suggests that SSRIs also have some efficacy in improving outcome in treatment-seeking alcoholics with a late onset of alcoholism (i.e.,after age 25) ),which includes most socially anxious alcoholics.
Whether CBT is beneficial in patients with comorbid social anxiety disorder and AUDs is not clear. A recent randomized,controlled clinical trial failed to demonstrate any benefit when the patients received simultaneous CBT for each condition ). In fact,treatment outcome was slightly better in the group that only received CBT for their alcohol problems than in the group that received CBT treatment for both conditions. These results highlight several important factors that must be addressed when treating individuals suffering from more than one psychiatric disorder. For example,which condition should be treated first? Should the treatments be integrated or separated? Should different treatment approaches be used (e.g.,pharmacotherapy for one disorder and psychotherapy for another)?
Treatment-seeking alcoholics are rarely assessed for the presence of social anxiety. Alcoholics with comorbid social anxiety disorder,however,are unlikely to benefit as much from traditional alcoholism treatment if their anxiety disorder is not treated. For example,such clients will probably resist or avoid participation in group therapy or self-help meetings,such as Alcoholics Anonymous. This resistance may be especially common in women with social anxiety ). Thus,in order to improve treatment outcomes it is important to determine whether comorbid social anxiety disorder is present among people seeking alcoholism treatment ). It is equally important to inquire about alcohol consumption in people seeking treatment for social anxiety problems in order to improve the outcome of treatment for social anxiety as well as to prevent or identify alcohol-related problems.
As described above,social anxiety disorder is treatable. If it is left untreated,however,repeated use of alcohol to self-medicate may result in the development of a secondary AUD,so that the individual suffers from two comorbid disorders requiring treatment. The onset of social anxiety disorder nearly always precedes the onset of an AUD,often by more than 10 years ). Because of this delay,this particular comorbidity is a primary target for intervention in order to prevent the development of an AUD.
1These two terms tend to be used interchangeably in the literature.
2Alcohol use disorders as defined in the DSM–IV include alcohol abuse and alcohol dependence.
3CBT also is frequently used in the treatment of AUDs,although the specific treatment approaches used and their target behaviors differ from those used for clients with social anxiety disorder.","department":"