恐慌症團體治療——從臨床到全國性自助團體

Group Therapy for Panic Disorder–From a Clinic to a National Association

恐慌症在1990年正式被列入美國精神醫學會精神科診斷手冊後引起各國的注意，除了藥物治療之外，認知行為治療亦受到肯定。我國門診負荷量過重，無法提供良好之醫病關係，精神科應有之心身全人治療往往淪為處方門診。有鑑於此，於1980年在台北市立療養院成立恐慌症團體心理治療，每次90分鐘，一週一次，共12週，團療內容包括衛生教育、認知治療、適應技巧、放鬆訓練、支持性心理治療、行為治療、團體藥物治療。團療每組十二人至十五人，由封閉團體開始，經一年後採納團員之建議成為開放式團體，資深團員可將其經驗傳授給新來團員（儼如生長班），經三年後（1993年）由參加過團療之病友發起成立中華民國生活調適愛心會，定期聚會，發行刊物，設立熱線，由治療之病友擔任志工，服務社區民眾。會友以恐慌症為主，但亦有焦慮症、憂鬱症、強迫神經症等精神官能症之病友，由十幾人之小團體延伸為全國性之自助團體，若以團療療效因子觀之，可容易瞭解其演變過程，十二週團療所產生之「凝聚力」、「利他思想」促進病友成立全國性互助會之動機，對社區求助之病友提供「希望灌注」、「認同摸仿」、「情緒傾洩」、「引導指示」。除了協助門診團療繼續成長為全國性之自助團體外，我們也作了兩項研究(一)恐慌症團體心理治療之效因研究；(二)團療之臨床追蹤研究。療效因子之研究顯示「凝聚力」、「普遍感」及「希望灌注」是最重要之效因，其次為「利他思想」、「引導指示」、「情感傾洩」及「自我瞭解」。一年之臨床追蹤研究顯示受過團療之病人不管有否合併藥物治療，其病情及社會功能，求助行為均較無團療而只受藥物治療者有更大的改善。本報告不只證明團療在臨床上之用途，也顯示團療之理論，功能應用到社會活動的潛在力。在急速轉變的社會，人與人之距離越疏遠，傳統及安全感逐漸消失時團療療效因子可催動各種人民團體，團療專業之貢獻，實無止境。

Since the introduction of panic disorder in the 1980 Diagnostic and Statistical Manual of Mental Disorders(DSM-III), the efficacy of cognitive and behavioral therapy for panic disorder has been documented in addition to that of pharmacotheray. In view of the unusual overload of outpatient clinics in Taiwan which serve merely as medication clinics in most cases, the author established in 1990 a panic disorder group therapy (GT) clinic in the outpatient department of the Taipei City Psychiatric Center. The GT contains the elements of health education, cognitive therapy, coping skill, relaxation training, supportive therapy, behavior therapy, and group medication. The group consists of 12-15 patients, who meet once a week for 90 minutes over 12 weeks. GT started from a closed group and shifted to an open group a year later from the suggestion of group members so that the senior members can help the junior members in the same group session. Three years later, some graduates of the GT organized a national association entitled ''Loving Heart Life Adjustment Group'' which functions as a self-help group for psychoneurotics, with particular attention to panic disorder patients. This national group meets periodically, publishes magazines, establishes hot lines and, serves the community by former patients. The majority of members are panic disorder patients, however, membership also include those of generalized anxiety disorder, dysthymia, major depression, and obsessive-compulsive disorder. The author believes that the therapeutic factors created by group therapy are the reason the national self-help organization has grown from a clinic of a dozen participants to a national organization with membership numbering in the thousands. The therapeutic factors include ''universality'', ''cohesiveness'', and ''altruism''. Volunteers further provide therapeutic factors such as ''instillation of hope'', ''imitation'', ''catharsis'', and ''imparting of information'' to the self-help group resulting in the rapid growth of the organization. Besides assisting the growth of a small group into a national organization, we have conducted two studies: (1) Therapeutic factors in panic disorder group therapy; and, (2) One year follow up study of panic disorder with different treatment modalities. In the first study, we have found that as a result of evaluation by patients, therapist and an independent evaluator, the most important therapeutic factors are: group cohesiveness, universality, and instillation of hope, followed by altruism, imparting of information, catharsis, and development of socializing techniques. The second study utilized symptoms, social functions and health seeking behavior as indicators of treatment efficacy. The result showed that the patients who received group therapy, regardless whether or not on medication, had greater improvement over those who did not receive group therapy but were on medication only. The present report showed not only the clinical effectiveness of group therapy but the great potential for social activities when the theory and function of group therapy were applied to the community beyond the clinic.