شناخت در بیماران مبتلا به اختلال اضطراب فراگیر و اختلال هراس: یک رویکرد آینده نگر

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had significantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had significantly more cognitions in the physical catastrophe category. Furthermore, GAD-patients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive specificity of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.

Over thirty years ago Beck applied the concept of negative schemas to explain the `thinking disorder' depression (Beck, 1996). Since then the cognitive behavior theory and therapy has gained a solid ground regarding a large area of different psychological and psychiatric disorders. The basis of Beck's cognitive model is now widely accepted and applied for different psychiatric, somatic and other health related problems (Salkovskis, 1996). According to Beck, (1976)and Beck et al., (1985)anxiety disorder patients have cognitions (schemata) regarding `personal danger'. The source of the threat varies between different types of anxiety disorders. Social phobics for example, fear negative evaluation, and panic disorder patients internal stimuli (physical sensations). Generalized anxiety disorder patients have cognitions concerning rejection, control, domination and depreciation (Beck et al., 1985). Several attempts have been made to test the empirical status of the cognitive model. Recently, the nature of cognitions have been investigated in order to more fully understand different emotional disorders (especially the anxiety disorders). These studies on the thought content have consistently showed a negative orientation of the thinking for different groups of anxiety disorder patients (see Chambless & Hope, 1996, for a review). A more thorough understanding of the mental content described by psychiatric patients will lead to the development of new, and better methods for treating and preventing emotional disorders (Wells & Butler, 1997).