Abstract：
UNASSIGNED: Patients who have experienced child abuse often have complex clinical presentations; whether a history of child abuse (HCA) affects psychotherapy outcomes is unclear. The authors examined relationships between HCA, clinical baseline variables, and change in these variables after three different psychotherapies for panic disorder (PD).
UNASSIGNED: Two hundred adults with PD (with or without agoraphobia) were randomly assigned to one of three treatments across two sites: panic-focused psychodynamic psychotherapy (PFPP), cognitive-behavioral therapy (CBT), or applied relaxation training (ART). Differences in demographic and clinical variables between those with and without HCA were compared. The primary analysis addressed odds of meeting clinical response criteria on the Panic Disorder Severity Scale (PDSS) between treatments, as moderated by HCA. This effect was examined via continuous outcomes on the PDSS and psychosocial functioning (Sheehan Disability Scale).
UNASSIGNED: Compared with patients without HCA (N=154), patients with HCA (N=46) experienced significantly more severe symptoms of PD (d=0.60), agoraphobia (d=0.47), and comorbid depression (d=0.46); significantly worse psychosocial impairment (d=0.63) and anxiety sensitivity (d=0.75); greater personality disorder burden (d=0.45)-particularly with cluster C disorders (d=0.47)-and more severe interpersonal problems (d=0.54). HCA significantly moderated the likelihood of clinical response, predicting nonresponse to ART (B=-2.05, 95% CI=-4.17 to -0.30, OR=0.13, z=-2.14, p=0.032) but not CBT or PFPP. HCA did not interact with treatment condition to predict slopes of PDSS change.
UNASSIGNED: The results of this study highlight the importance of HCA in formulating treatment recommendations. Increased awareness of HCA\'s effects on severity of PD and treatment responsiveness among patients with PD may improve outcomes.
UNASSIGNED: Two hundred adults with PD (with or without agoraphobia) were randomly assigned to one of three treatments across two sites: panic-focused psychodynamic psychotherapy (PFPP), cognitive-behavioral therapy (CBT), or applied relaxation training (ART). Differences in demographic and clinical variables between those with and without HCA were compared. The primary analysis addressed odds of meeting clinical response criteria on the Panic Disorder Severity Scale (PDSS) between treatments, as moderated by HCA. This effect was examined via continuous outcomes on the PDSS and psychosocial functioning (Sheehan Disability Scale).
UNASSIGNED: Compared with patients without HCA (N=154), patients with HCA (N=46) experienced significantly more severe symptoms of PD (d=0.60), agoraphobia (d=0.47), and comorbid depression (d=0.46); significantly worse psychosocial impairment (d=0.63) and anxiety sensitivity (d=0.75); greater personality disorder burden (d=0.45)-particularly with cluster C disorders (d=0.47)-and more severe interpersonal problems (d=0.54). HCA significantly moderated the likelihood of clinical response, predicting nonresponse to ART (B=-2.05, 95% CI=-4.17 to -0.30, OR=0.13, z=-2.14, p=0.032) but not CBT or PFPP. HCA did not interact with treatment condition to predict slopes of PDSS change.
UNASSIGNED: The results of this study highlight the importance of HCA in formulating treatment recommendations. Increased awareness of HCA\'s effects on severity of PD and treatment responsiveness among patients with PD may improve outcomes.
摘要：
■经历过虐待儿童的患者通常具有复杂的临床表现；虐待儿童史（HCA）是否会影响心理治疗结果尚不清楚。作者研究了HCA之间的关系，临床基线变量，以及在三种不同的恐慌症（PD）心理治疗后这些变量的变化。
■两百名患有PD（有或没有广场恐惧症）的成年人被随机分配到两个地点的三种治疗方法之一：以恐慌为中心的心理动力心理治疗（PFPP），认知行为疗法（CBT），或应用放松训练（ART）。比较了有和没有HCA的人口统计学和临床变量的差异。主要分析解决了治疗之间达到恐慌症严重程度量表（PDSS）临床反应标准的几率，由HCA主持。通过对PDSS和心理社会功能的连续结果（Sheehan残疾量表）检查了这种影响。
■与没有HCA的患者（N=154）相比，HCA患者（N=46）出现明显更严重的PD症状（d=0.60），广场恐惧症（d=0.47），和共患抑郁症（d=0.46）；明显更差的心理社会损害（d=0.63）和焦虑敏感性（d=0.75）；更大的人格障碍负担（d=0.45）-特别是C类群障碍（d=0.47）-和更严重的人际关系问题（d=0.54）。HCA显著降低了临床反应的可能性，预测对ART无反应(B=-2.05，95%CI=-4.17至-0.30，OR=0.13，z=-2.14，p=0.032)，但不预测CBT或PFPP。HCA不与治疗条件相互作用以预测PDSS变化的斜率。
■这项研究的结果突出了HCA在制定治疗建议中的重要性。提高PD患者对HCA对PD严重程度和治疗反应性的影响的认识可能会改善预后。
■两百名患有PD（有或没有广场恐惧症）的成年人被随机分配到两个地点的三种治疗方法之一：以恐慌为中心的心理动力心理治疗（PFPP），认知行为疗法（CBT），或应用放松训练（ART）。比较了有和没有HCA的人口统计学和临床变量的差异。主要分析解决了治疗之间达到恐慌症严重程度量表（PDSS）临床反应标准的几率，由HCA主持。通过对PDSS和心理社会功能的连续结果（Sheehan残疾量表）检查了这种影响。
■与没有HCA的患者（N=154）相比，HCA患者（N=46）出现明显更严重的PD症状（d=0.60），广场恐惧症（d=0.47），和共患抑郁症（d=0.46）；明显更差的心理社会损害（d=0.63）和焦虑敏感性（d=0.75）；更大的人格障碍负担（d=0.45）-特别是C类群障碍（d=0.47）-和更严重的人际关系问题（d=0.54）。HCA显著降低了临床反应的可能性，预测对ART无反应(B=-2.05，95%CI=-4.17至-0.30，OR=0.13，z=-2.14，p=0.032)，但不预测CBT或PFPP。HCA不与治疗条件相互作用以预测PDSS变化的斜率。
■这项研究的结果突出了HCA在制定治疗建议中的重要性。提高PD患者对HCA对PD严重程度和治疗反应性的影响的认识可能会改善预后。
