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Basile VT, Newton-John T, Wootton BM. Treatment histories, barriers, and preferences for individuals with symptoms of generalized anxiety disorder. J Clin Psychol 2024; 80:1286-1305. [PMID: 38384113 DOI: 10.1002/jclp.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
Generalized anxiety disorder (GAD) is a prevalent and chronic mental health condition, associated with considerable individual and economic burden. Despite the availability of effective treatments, many individuals do not access support. The current study explores treatment histories, barriers to help-seeking, and cognitive behavioral therapy (CBT) treatment preferences for individuals with clinically significant GAD symptoms. The utility of Health Belief Model (HBM) in predicting help-seeking is also examined. A cross-sectional design with 127 participants (Mage = 29.17; SD = 11.86; 80.3% female) was used. Sixty-two percent of participants reported previously seeking psychological treatment, and approximately 28% received CBT in the first instance. The most influential treatment barriers were a desire to solve the problem on one's own (M = 1.96, SD = 0.96), followed by affordability (M = 1.75, SD = 1.15) and feeling embarrassed or ashamed (M = 1.75, SD = 1.06). The most preferred treatment modes were in-person individual treatment (M = 7.59, SD = 2.86) followed by remote treatment via videoconferencing (M = 4.31, SD = 3.55). Approximately 38% of the variance in intention to seek treatment was associated with the HBM variables, with perceived benefit of treatment being the strongest predictor. Results have the potential to inform mental health service delivery by reducing treatment barriers and aligning public health campaigns with benefits of psychological treatments.
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Affiliation(s)
- Vesna Trenoska Basile
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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2
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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3
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Perczel-Forintos D, Kovács IÁ, Elek LP. [Intensive cognitive behavioral group therapy for the treatment of panic disorder]. Orv Hetil 2023; 164:1665-1672. [PMID: 37865926 DOI: 10.1556/650.2023.32892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. OBJECTIVE Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. METHOD Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. RESULTS Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. DISCUSSION AND CONCLUSION Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.
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Affiliation(s)
- Dóra Perczel-Forintos
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Klinikai Pszichológia Tanszék Budapest, Üllői út 25., 1091 Magyarország
| | - Illés Áron Kovács
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Klinikai Pszichológia Tanszék Budapest, Üllői út 25., 1091 Magyarország
| | - Lívia Priyanka Elek
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, Klinikai Pszichológia Tanszék Budapest, Üllői út 25., 1091 Magyarország
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Stanley B, Brodsky B, Monahan M. Brief and Ultra-Brief Suicide-Specific Interventions. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:129-136. [PMID: 37201146 PMCID: PMC10172548 DOI: 10.1176/appi.focus.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The rising rates of suicide warrant effective treatments that can quickly help stabilize suicidal individuals and prevent future suicidal crises from occurring. Across the past few decades, there has been a rise in the development of ultra-brief (1-4 sessions) and brief suicide-specific interventions (6-12 sessions) to meet this need. This article reviews several prominent ultra-brief and brief interventions, including the Teachable Moment Brief Intervention, Attempted Suicide Short Intervention Program, Safety Planning Intervention, Crisis Response Planning, Cognitive Therapy for Suicide Prevention, Brief Cognitive-Behavioral Therapy for Suicide Prevention, Collaborative Assessment and Management of Suicidality, and the Coping Long-Term With Active Suicide Program. A brief review of each interventions' evidence base is also provided. Current challenges and directions for future research in testing the efficacy and effectiveness of suicide prevention initiatives are discussed.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Beth Brodsky
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
| | - Maureen Monahan
- Department of Psychiatry, Columbia University Irving Medical Center, New York (all authors); Molecular Imaging and Neuropathology Division (Stanley) and Division of Behavioral Health Services and Policy Research (all authors), New York State Psychiatric Institute, New York
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Zainal NH, Hellberg SN, Kabel KE, Hotchkin CM, Baker AW. Cognitive behavioral therapy (CBT) plus attention bias modification (ABM) reduces anxiety sensitivity and depressive symptoms in panic disorder: A pilot randomized trial. Scand J Psychol 2023. [PMID: 36707979 DOI: 10.1111/sjop.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cognitive bias theories propose that reducing threat hypervigilance in mental disorders can augment cognitive behavioral therapy (CBT) outcomes. However, no studies have tested whether adding attention bias modification (ABM) can effectively enhance CBT's effects on anxiety sensitivity (AS), electromyography (EMG), and skin conductance (SC) for panic disorder (PD). This pilot randomized controlled trial (RCT) thus aimed to evaluate the efficacy of CBT + ABM (vs. CBT plus attention training placebo; PBO) on those outcomes. METHOD This study is a secondary analysis (Baker et al., 2020). Adults with PD were randomized to receive CBT + ABM (n = 11) or CBT + PBO (n = 12). Before each of the first five CBT sessions, CBT + ABM and CBT + PBO participants completed a 15-min ABM task or attention training PBO, respectively. AS and depression severity as well as SC and EMG during habituation to a loud-tone startle paradigm were assessed. Hierarchical Bayesian analyses were conducted. RESULTS During pre-post-treatment and pre-follow-up, CBM + ABM (vs. CBT + PBO) led to a notably greater reduction in ASI-Physical (between-group d = -1.26 to -1.25), ASI-Cognitive (d = -1.16 to -1.10), and depression severity (d = -1.23 to -0.99). However, no between-group difference was observed for ASI-Social, EMG, or SC indices. DISCUSSION Adding a brief computerized ABM intervention to CBT for PD protocols may enhance therapeutic change.
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Affiliation(s)
- Nur Hani Zainal
- Department of Healthcare Policy, Harvard Medical School, Boston, MA, USA
| | - Samantha N Hellberg
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Kabel
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Claire M Hotchkin
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda W Baker
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Sung SC, Lim L, Lim SH, Finkelstein EA, Chin SLH, Annathurai A, Chakraborty B, Strauman TJ, Pollack MH, Ong MEH. Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety. BMC Psychiatry 2022; 22:795. [PMID: 36527018 PMCID: PMC9756520 DOI: 10.1186/s12888-022-04387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Approximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1-2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms. METHODS This multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore's largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone. DISCUSSION This trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.
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Affiliation(s)
- Sharon C. Sung
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Leslie Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Swee Han Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Eric A. Finkelstein
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Steven Lim Hoon Chin
- grid.413815.a0000 0004 0469 9373Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Annitha Annathurai
- grid.508163.90000 0004 7665 4668Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886 Singapore
| | - Bibhas Chakraborty
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.4280.e0000 0001 2180 6431National University of Singapore, 6 Science Drive 2, Singapore, 117546 Singapore ,grid.26009.3d0000 0004 1936 7961Duke University, 2424 Erwin Road, Suite 1102, Durham, NC 27710 USA
| | - Timothy J. Strauman
- grid.189509.c0000000100241216Duke University Medical Center, 10 Duke Medicine Cir, Durham, NC 27710 USA
| | - Mark H. Pollack
- grid.240684.c0000 0001 0705 3621Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612 USA ,grid.476678.c0000 0004 5913 664XSage Therapeutics, 215 First Street, Cambridge, MA 02142 USA
| | - Marcus Eng Hock Ong
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
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Bahcivan O, Gutierrez-Maldonado J, Estapé T. A single-session Mindfulness-Based Swinging Technique vs. cognitive disputation intervention among women with breast cancer: A pilot randomised controlled study examining the efficacy at 8-week follow-up. Front Psychol 2022; 13:1007065. [PMID: 36337479 PMCID: PMC9632732 DOI: 10.3389/fpsyg.2022.1007065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/27/2022] [Indexed: 09/19/2023] Open
Abstract
Objective Previously Mindfulness-Based Swinging Technique (MBST)'s immediate efficacy for overcoming psychological concerns has recently received empirical support, yet its longer-term efficacy needed to be evaluated among women with breast cancer. The objective of this study was to assess and report the efficacy of MBST intervention among breast cancer patients for hopelessness, anxiety, depression, self-efficacy, oxygen (SpO2) intensity, and heart rate-beats per minute (HR-bpm) at an 8-week period. Method The State-Trait Anxiety Inventory, The Emotion Thermometer, Hospital Anxiety and Depression Scale, Self-Efficacy for Managing Chronic Disease, and Beck's Hopelessness Scale were used for assessing the intervention's outcome; 149 BC patients were randomly assigned into two groups (equal-mean-age, p = 0.262). The participants in the control group (CG, n = 73) received Cognitive Behavioural Therapy (CBT)-Cognitive-Disputation (CBT-CD) for 20 min, and intervention group (IG, n = 76) received MBST intervention. No additional psychological interventions were given between week-1 and week-8. Result Outcomes of the 8-week post-treatment follow-up exhibited significantly higher improvements in all evaluated-measurements for CG, and some for IG with large effect size in the following: anxiety (CG p < 0.05, r = 0.57; IG p < 0.05, r = 0.44) and depression levels (CG p < 0.05, r = 0.43). It increased self-efficacy for managing disease (CG p < 0.05, r = 0.49; IG p < 0.05, r = 0.41) and hopefulness (CG p < 0.05, r = 0.59; IG p < 0.05, r = 0.46), and saturation levels measured by pulse-meter/oximeter (CG p < 0.05, r = 0.49; IG p < 0.05, r = 0.32). Conclusions Both CBT-CD and MBST have been found to be efficacious interventions to shorten the psychotherapy duration for reducing clinical anxiety and hopelessness as well as increase self-efficacy for BC women. This may have a distinct clinical importance for supporting BC patient's adherence-to-treatment since CBT-CD could be an alternative technique to MBST as a brief intervention. In future studies, the effectiveness of MBST through adapting to virtual reality and other online delivery methods should be examined.
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Affiliation(s)
- Ozan Bahcivan
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Psiko-Onkologlar Dernegi (Turkish Psycho-Oncological Association), Izmir, Turkey
| | - Jose Gutierrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
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8
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Hunt C, Krauss A, Hiatt E, Teng EJ. Predictors of symptom reduction following intensive weekend treatment for panic disorder: An exploratory study of veterans. J Affect Disord 2022; 308:298-304. [PMID: 35429544 DOI: 10.1016/j.jad.2022.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/07/2022] [Accepted: 04/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent evidence implicates intensive panic control treatment (IPCT) - a full panic control treatment protocol compressed into a single weekend - as a viable alternative for Veterans with panic disorder who are unable or unwilling to commit to standard weekly cognitive behavioral therapy (CBT). However, no studies to date have examined pretreatment predictors of response to IPCT. Knowledge of such predictors may be important for understanding which Veterans are best suited for IPCT relative to standard CBT. METHODS Participants were military Veterans with a primary diagnosis of panic disorder (N = 26) who participated in three open trials of IPCT. Pretreatment predictors were tested within linear regression models used to predict panic disorder severity at 2-week and 6-month follow-up assessments. Pretreatment predictors included: Panic disorder severity, agoraphobic avoidance, PTSD symptoms, anxiety sensitivity, and age. RESULTS Pretreatment symptoms of PTSD predicted reduced treatment response at 2-week but not 6-month follow-up, whereas pretreatment anxiety sensitivity predicted reduced response at 6-month but not 2-week follow-up. LIMITATIONS Current findings are tempered by the exploratory nature of the analyses and a small sample. CONCLUSIONS Our study offers tentative evidence that success in IPCT may be linked to a distinct pretreatment profile relative to that of standard weekly therapy. These preliminary findings should be confirmed in larger studies that directly compare pretreatment predictors of intensive versus standard weekly CBT for panic disorder.
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Affiliation(s)
- Christopher Hunt
- Michael E. DeBakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, United States of America
| | - Alison Krauss
- Michael E. DeBakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, United States of America
| | - Emily Hiatt
- Michael E. DeBakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, United States of America; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, United States of America
| | - Ellen J Teng
- Michael E. DeBakey Veteran's Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, United States of America; Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, United States of America; South Central Mental Illness Research, Education, and Clinical Center, United States of America.
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Maximizing the non-specific factors in brief cognitive behavioral therapy for panic disorder and agoraphobia: A multiple baseline case series documenting feasibility and initial efficacy. Asian J Psychiatr 2022; 72:103069. [PMID: 35339872 DOI: 10.1016/j.ajp.2022.103069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
There is evidence for non-specific factors impacting treatment outcomes, with pragmatic concerns regarding the need to popularize briefer formats of cognitive behavioral therapy (CBT). The need to have more culturally suitable and acceptable forms of CBT is also indicated. We evaluated the feasibility and efficacy of a brief 5 session CBT (bCBT) in participants (N = 4) with panic disorder (PD) and agoraphobia, using a non-concurrent multiple baseline design. In this case series, efforts were made to maximize non-specific factors of psychotherapy in bringing about treatment outcomes. Reliable and significant treatment effects were observed at post-intervention and follow-up assessments. The present study offers preliminary evidence of a bCBT protocol that comprises the efforts to maximize the non-specific factors in psychotherapy such as credibility, expectancy, and the therapeutic alliance in bringing treatment outcomes; however, further controlled evaluation is warranted. We also discuss the mechanisms contributing to these treatment outcomes in the present protocol.
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10
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS One 2022; 17:e0264368. [PMID: 35231039 PMCID: PMC8887746 DOI: 10.1371/journal.pone.0264368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.
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Affiliation(s)
- Jean-Daniel Carrier
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- * E-mail:
| | - Frances Gallagher
- School of nursing, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Alain Vanasse
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
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11
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Masdrakis VG, Legaki EM, Papageorgiou C, Markianos M. Stress Hormones as Predictors of Response to Cognitive Behavior Therapy in Panic Disorder. Neuropsychobiology 2022; 80:401-410. [PMID: 33735885 DOI: 10.1159/000514073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Data regarding the potential association between the outcome of psychotherapy of panic disorder (PD) and biological parameters are few. In 21 (16 females) consecutively referred, medication-free, acutely ill PD outpatients, without comorbidities, except agoraphobia, we systematically explored for potential neuroendocrine and clinical correlates of response to a brief cognitive behavior therapy (CBT). METHODS Cortisol and adrenocorticotropic hormone (ACTH) basal plasma levels were measured. Measures of psychopathology: (a) Symptom Checklist-90-Revised (SCL-90-R), (b) Clinical Global Impressions-Improvement (CGI-I) Scale, (c) Agoraphobic Cognitions Questionnaire (ACQ), and (d) Mobility Inventory (MI)-alone subscale. RESULTS Nonresponders to CBT (CGI-I >2; N = 6) - as compared to the responders (CGI-I ≤2; N = 15) - demonstrated significantly higher cortisol and ACTH basal plasma concentrations. These differences were much stronger when only female patients (nonresponders = 4; responders = 12) were taken into consideration. Regarding psychopathology, nonresponders to CBT suffered from more severe agoraphobia (MI-alone) at baseline. On the contrary, more intense manifestations of anger (SCL-90-R) at baseline were associated with a better treatment outcome. Response to CBT was associated with significant reductions in all SCL-90-R subscales, more pronounced for "phobic anxiety" and "anxiety" subscales. CONCLUSIONS This study suggests that in acutely ill, medication-free PD patients, response to CBT may be associated with certain hormonal and clinical parameters at baseline.
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Affiliation(s)
- Vasilios G Masdrakis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece,
| | - Emilia-Maria Legaki
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Papageorgiou
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Markianos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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12
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Gjengedal RGH, Reme SE, Osnes K, Lagerfeld SE, Blonk RWB, Sandin K, Berge T, Hjemdal O. Work-focused therapy for common mental disorders: A naturalistic study comparing an intervention group with a waitlist control group. Work 2021; 66:657-667. [PMID: 32623425 PMCID: PMC7504991 DOI: 10.3233/wor-203208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Common mental disorders (CMD) are leading causes of sickness absence. Treatments for CMD that both reduce symptoms and support work participation urgently need to be developed. OBJECTIVE: Determine the potential effects of work-focused therapy combining work interventions with either meta cognitive therapy or cognitive behavioural therapy (W-MCT/CBT) for patients with CMD on sick leave. METHODS: Naturalistic study with a quasi-experimental approach. Pre- and post-scores (return to work, symptoms, return-to-work self-efficacy, clinical recovery from depression and anxiety) were compared between the intervention group (n = 87) who received immediate treatment over an average of 10.40 sessions (SD = 3.09) and the non-randomized waitlist control group (n = 95) that had waited an average of 11.18 weeks (SD = 2.29). RESULTS: Significantly more patients returned fully to work in the intervention group (41.4%) than the control group (26.3%). Effect sizes for self-efficacy scores, depression and anxiety were large in the intervention group (d = 1.28, 1.01, 1.58), and significantly lower in the control group (d = 0.60, 0.14, 0.45). Significantly more patients in the treatment group than control group recovered from depression (54.1% vs. 12.8%) and anxiety (50.0% vs.10.6%). CONCLUSIONS: W-MCT/CBT may be an effective intervention for patients on sick leave due to CMD.
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Affiliation(s)
- Ragne G H Gjengedal
- Diakonhjemmet Hospital, Oslo, Norway.,Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Roland W B Blonk
- Tilburg University, Tilburg, The Netherlands.,TNO, Institute for Applied Scientific Research, The Netherlands
| | - Kenneth Sandin
- Diakonhjemmet Hospital, Oslo, Norway.,Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Odin Hjemdal
- Diakonhjemmet Hospital, Oslo, Norway.,Norwegian University of Science and Technology, Trondheim, Norway
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13
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Wootton BM, Macgregor A. Accelerated outpatient individual cognitive‐behaviour therapy for panic disorder: A case study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Bethany M. Wootton
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Amy Macgregor
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
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14
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Baker AW, Hellberg SN, Jacoby RJ, Losiewicz OM, Orr S, Marques L, Simon NM. A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes. J Behav Ther Exp Psychiatry 2020; 68:101568. [PMID: 32224333 DOI: 10.1016/j.jbtep.2020.101568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Studies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment. METHODS Adults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment. RESULTS Across both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed. LIMITATIONS This study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat. CONCLUSIONS This pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.
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Affiliation(s)
- A W Baker
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - S N Hellberg
- University of North Carolina Chapel Hill Department of Psychology and Neuroscience, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, USA.
| | - R J Jacoby
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - O M Losiewicz
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA.
| | - S Orr
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - L Marques
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - N M Simon
- Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; New York University Langone Health Department of Psychiatry, One Park Avenue, 8th floor, New York, NY, 10016, USA.
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15
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Kampman M, van Balkom AJLM, Broekman T, Verbraak M, Hendriks GJ. Stepped-care versus treatment as usual in panic disorder: A randomized controlled trial. PLoS One 2020; 15:e0237061. [PMID: 32790718 PMCID: PMC7425947 DOI: 10.1371/journal.pone.0237061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Stepped-care (SC) models for anxiety disorders are implemented on a large scale and are assumed to be as effective for the greater majority of patients as more intensive treatment schemes. To compare the outcomes of SC and international guideline-based treatment (Treatment as Usual: TAU) for panic disorder, a total of 128 patients were randomized to either SC or TAU (ratio 2: 1, respectively) using a computer generated algorithm. They were treated in four mental health care centres in the Netherlands after therapists had been trained in SC by a senior expert therapist. SC comprised 10-week guided self-help (pen-and-paper version) followed, if indicated, by 13-week manualized face-to-face cognitive behavioural therapy (CBT), with medication- if prescribed- kept constant. TAU consisted of 23-week regular face-to-face CBT (RCBT) with medication -when prescribed- also kept constant. The means of the attended sessions in the SC condition was 5.9 (SD = 4.8) for ITT and 9.6 (SD = 9.6) for the RCBT condition. The difference in the number of attended sessions between the conditions was significant (t(126) = -3.87, p < .001). Remission rates between treatment conditions did not differ significantly (SC: 44.5%; RCBT: 53.3%) and symptom reduction was similar. Stepping up SC treatment to face-to-face CBT showed a minimal additional effect. Importantly, drop-out rates differed significantly for the two conditions (SC: 48.2%; RCBT: 26.7%). SC was effective in the treatment of panic disorder in terms of symptom reduction and remission rate, but dropout rates were twice as high as those seen in RCBT, with the second phase of SC not substantially improving treatment response. However, SC required significantly less therapist contact time compared to RCBT, and more research is needed to explore predictors of success for guided self-help interventions to allow treatment intensity to be tailored to patients' needs and preferences.
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Affiliation(s)
- Mirjam Kampman
- Overwaal, Centre of Expertise for Anxiety Disorders, OCD, and PTSD part of Institute for Integrated Mental Health Care “Pro Persona”, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- * E-mail:
| | - Anton J. L. M. van Balkom
- Amsterdam UMC, Psychiatry, Amsterdam Public Health Research Institute and GGZ inGeest, Specialized Mental Health Care, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Marc Verbraak
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- HSK Groep, Arnhem, The Netherlands
| | - Gert-Jan Hendriks
- Overwaal, Centre of Expertise for Anxiety Disorders, OCD, and PTSD part of Institute for Integrated Mental Health Care “Pro Persona”, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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16
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Levy HC, Worden BL, Davies CD, Stevens K, Katz BW, Mammo L, Diefenbach GJ, Tolin DF. The dose-response curve in cognitive-behavioral therapy for anxiety disorders. Cogn Behav Ther 2020; 49:439-454. [PMID: 32631134 DOI: 10.1080/16506073.2020.1771413] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous studies examining the dose-response curve in psychotherapy have suggested that 11-19 sessions may be necessary for at least 50% of individuals to show clinically significant improvement. However, this curve has not been examined specifically for cognitive-behavioral therapy (CBT) for anxiety disorders, for which a more rapid recovery curve may be expected. Survival analysis was used to assess the dose-response curve for 201 patients with anxiety disorders who received weekly CBT at an anxiety specialty clinic. The primary outcome measure was the Outcome Questionnaire-45.2, which patients completed prior to each treatment session. Sixty-four percent of the sample achieved reliable change, and this response occurred in approximately five sessions on average. Fifty percent of the sample achieved clinically significant improvement, which occurred in approximately eight sessions on average. The findings suggest that earlier response may be expected in CBT for anxiety disorders, and are discussed in terms of potential ways to further improve response rates for this treatment.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Blaise L Worden
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Carolyn D Davies
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Kimberly Stevens
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Benjamin W Katz
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Liya Mammo
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA
| | - Gretchen J Diefenbach
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA.,Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living , Hartford, CT, USA.,Department of Psychiatry, Yale University School of Medicine , New Haven, CT, USA
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17
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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18
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Mitsopoulou T, Kasvikis Y, Koumantanou L, Giaglis G, Skapinakis P, Mavreas V. Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia. Psychother Res 2019; 30:776-787. [PMID: 31510890 DOI: 10.1080/10503307.2019.1663956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.
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Affiliation(s)
- Titika Mitsopoulou
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece.,Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Yiannis Kasvikis
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Lia Koumantanou
- Behaviour Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Georgios Giaglis
- School of Psychology, Aristotle University, Thessaloniki, Greece
| | - Petros Skapinakis
- Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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19
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Kotianova A, Kotian M, Slepecky M, Chupacova M, Prasko J, Tonhajzerova I. The differences between patients with panic disorder and healthy controls in psychophysiological stress profile. Neuropsychiatr Dis Treat 2018; 14:435-441. [PMID: 29445280 PMCID: PMC5808685 DOI: 10.2147/ndt.s153005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Alarming somatic symptoms, in particular, cardiovascular symptoms, are the characteristic feature of panic attacks. Increased cardiac mortality and morbidity have been found in these patients. Power spectral analysis of electrocardiogram R-R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Our study aimed to compare patients with panic disorder and healthy controls in heart rate variation (HRV) parameters (very-low-frequency [VLF], low-frequency [LF], and high-frequency [HF] band components of R-R interval) in baseline and during the response to the mental task. SUBJECTS AND METHODS We assessed psychophysiological variables in 33 patients with panic disorder (10 men, 23 women; mean age 35.9±10.7 years) and 33 age- and gender-matched healthy controls (10 men, 23 women; mean age 35.8±12.1 years). Patients were treatment naïve. Heart rate, blood pressure, muscle tension, and HRV in basal conditions and after the psychological task were assessed. Power spectrum was computed for VLF (0.003-0.04 Hz), LF (0.04-0.15 Hz), and HF (0.15-0.40 Hz) bands using fast Fourier transformation. RESULTS In the baseline period, the VLF band was significantly lower in panic disorder group compared to controls (p<0.005). In the period of mental task, the LF/HF ratio was significantly higher in panic disorder patients compared to controls (p<0.05). No significant differences were found in the remaining parameters. There was a significant difference in ΔHF and ΔLF/HF ratio between patients and controls, with Δ increasing in patients and decreasing in controls. CONCLUSION These findings revealed that patients suffering from panic disorder were characterized by relative sympathetic dominance (reactivity) in response to mental stress compared with healthy controls.
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Affiliation(s)
- Antonia Kotianova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | - Michal Kotian
- Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic
| | | | - Jan Prasko
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic.,Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, Czech Republic
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.,Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
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20
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Banducci AN, Bonn-Miller MO, Timko C, Rosen CS. Associations between residential treatment length, PTSD, and outpatient healthcare utilization among veterans. Psychol Serv 2017; 15:529-535. [PMID: 29265844 DOI: 10.1037/ser0000204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Premature discontinuation of posttraumatic stress disorder (PTSD) treatment is generally associated with poorer outcomes for veterans with PTSD. What is less clear is whether treatment benefits, as a function of treatment length, persist, as well as predict less future mental health care utilization. We sought to determine whether length of stay (LOS) in residential PTSD treatment predicted discharge PTSD symptom severity and outpatient mental health care utilization. We hypothesized discharge PTSD Checklist (PCL) scores would mediate the relations between LOS in residential treatment and outpatient mental health care utilization. The current study included 740 veterans who received residential PTSD treatment within 5 VA hospitals and completed intake and discharge assessments, including the PTSD Checklist (PCL). Information about LOS in residential treatment and outpatient mental health care utilization was obtained from the National Patient Care Database. We examined the relations between residential LOS, discharge Posttraumatic Stress Disorder Checklist (PCL), and outpatient mental health care utilization. Nonparametric bootstrapping was utilized to test for the significance of the indirect effect. Veterans who stayed in residential treatment longer had lower PCL scores at discharge (est. = -2.50, SE = .51, p < .001), and veterans with lower PCL scores at discharge sought fewer outpatient mental health visits (est. = .31, SE = .14, p = .03). A bias-corrected bootstrap confidence interval for the indirect effect (ab = -.77) based on 10,000 bootstrap samples was entirely below zero (-1.72 to -.05). This indicates discharge PCL mediated the relations between LOS and outpatient mental health care utilization, such that individuals with a longer LOS in residential PTSD treatment had lower PCL scores at discharge and thus utilized less outpatient mental health care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Marcel O Bonn-Miller
- National Center for PTSD and Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Craig S Rosen
- National Center for PTSD and Center for Innovation to Implementation, VA Palo Alto Health Care System
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21
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Meuret AE, Simon E, Bhaskara L, Ritz T. Ultra-brief behavioral skills trainings for blood injection injury phobia. Depress Anxiety 2017; 34:1096-1105. [PMID: 28294471 DOI: 10.1002/da.22616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Blood injection injury (BII) phobia is common, with debilitating consequences to the health and well being of many of its sufferers. BII phobia presents with a unique fear response that can involve drops in blood pressure and ultimately fainting. The aim of this study was to provide proof of concept for a line of brief, easy to implement, video-based interventions for reducing phobic avoidance and fears in BII sufferers. One of the interventions was a novel Hypoventilation Respiratory Training (HRT) aimed at reducing the exaggerated ventilation response (hyperventilation) seen in BII phobia. The response has been linked to cerebral vasoconstriction and fainting symptoms. METHOD Sixty BII patients were randomly assigned to one of three 12-min video-guided trainings: Symptom-Associated Tension (SAT) training, Relaxation Skills Training (RST), or HRT. Experiential and cardiorespiratory activity to phobic stimuli was assessed before and after training. RESULTS Both SAT and HRT resulted in overall greater reductions of phobic fears and symptoms than RST. SAT significantly increased heart rate during exposure, and HRT led to significantly reduced ventilation, increases in PCO2 , and elevated blood pressure throughout exposure and recovery. Treatment expectancy was rated equally high across conditions, whereas credibility ratings were highest for HRT. CONCLUSIONS Brief, video-based instructions in muscle tension and normocapnic breathing are effective in reducing BII symptom severity and require minimal time and expertise. HRT may be particularly helpful in reducing fainting caused by cerebral vasoconstriction.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Erica Simon
- Palo Alto Veterans Institute for Research, Palo Alto, CA, USA.,National Center for PTSD-Dissemination and Training Division, Palo Alto VA Healthcare System, Livermore, CA, USA
| | - Lavanya Bhaskara
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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22
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Tolin DF, Billingsley AL, Hallion LS, Diefenbach GJ. Low pre-treatment end-tidal CO 2 predicts dropout from cognitive-behavioral therapy for anxiety and related disorders. Behav Res Ther 2016; 90:32-40. [PMID: 27960095 DOI: 10.1016/j.brat.2016.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/26/2022]
Abstract
Recent clinical trial research suggests that baseline low end-tidal CO2 (ETCO2, the biological marker of hyperventilation) may predict poorer response to cognitive-behavioral therapy (CBT) for anxiety-related disorders. The present study examined the predictive value of baseline ETCO2 among patients treated for such disorders in a naturalistic clinical setting. Sixty-nine adults with a primary diagnosis of a DSM-5 anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder completed a 4-min assessment of resting ETCO2, and respiration rate (the first minute was analyzed). Lower ETCO2 was not associated with a diagnosis of panic disorder, and was associated with lower subjective distress ratings on certain measures. Baseline ETCO2 significantly predicted treatment dropout: those meeting cutoff criteria for hypocapnia were more than twice as likely to drop out of treatment, and ETCO2 significantly predicted dropout beyond other pre-treatment variables. Weekly measurement suggested that the lower-ETCO2 patients who dropped out were not responding well to treatment prior to dropout. The present results, along with previous clinical trial data, suggest that lower pre-treatment ETCO2 is a negative prognostic indicator for CBT for anxiety-related disorders. It is suggested that patients with lower ETCO2 might benefit from additional intervention that targets respiratory abnormality.
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Affiliation(s)
- David F Tolin
- The Institute of Living, United States; Yale University School of Medicine, United States.
| | | | | | - Gretchen J Diefenbach
- The Institute of Living, United States; Yale University School of Medicine, United States
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23
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Otto MW, Kredlow MA, Smits JAJ, Hofmann SG, Tolin DF, de Kleine RA, van Minnen A, Evins AE, Pollack MH. Enhancement of Psychosocial Treatment With D-Cycloserine: Models, Moderators, and Future Directions. Biol Psychiatry 2016; 80:274-283. [PMID: 26520240 PMCID: PMC4808479 DOI: 10.1016/j.biopsych.2015.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 01/02/2023]
Abstract
Advances in the understanding of the neurobiology of fear extinction have resulted in the development of d-cycloserine (DCS), a partial glutamatergic N-methyl-D-aspartate agonist, as an augmentation strategy for exposure treatment. We review a decade of research that has focused on the efficacy of DCS for augmenting the mechanisms (e.g., fear extinction) and outcome of exposure treatment across the anxiety disorders. Following a series of small-scale studies offering strong support for this clinical application, more recent larger-scale studies have yielded mixed results, with some showing weak or no effects. We discuss possible explanations for the mixed findings, pointing to both patient and session (i.e., learning experiences) characteristics as possible moderators of efficacy, and offer directions for future research in this area. We also review recent studies that have aimed to extend the work on DCS augmentation of exposure therapy for the anxiety disorders to DCS enhancement of learning-based interventions for addiction, anorexia nervosa, schizophrenia, and depression. Here, we attend to both DCS effects on facilitating therapeutic outcomes and additional therapeutic mechanisms beyond fear extinction (e.g., appetitive extinction, hippocampal-dependent learning).
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24
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Otto MW, Pollack MH, Dowd SM, Hofmann SG, Pearlson G, Szuhany KL, Gueorguieva R, Krystal JH, Simon NM, Tolin DF. RANDOMIZED TRIAL OF D-CYCLOSERINE ENHANCEMENT OF COGNITIVE-BEHAVIORAL THERAPY FOR PANIC DISORDER. Depress Anxiety 2016; 33:737-45. [PMID: 27315514 PMCID: PMC5958622 DOI: 10.1002/da.22531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Initial studies have provided a mixed perspective of the efficacy of d-cycloserine (DCS) for augmenting the efficacy of exposure-based cognitive behavioral therapy (CBT) for panic disorder. In this multicenter trial, we examine the magnitude of DCS augmentation effects for an ultra-brief program of CBT. METHODS We conducted a double-blind, controlled trial at three treatment sites, randomizing 180 adults with a primary diagnosis of panic disorder to five sessions of treatment, with study pill (50 mg DCS or matching placebo) administered 1 hr prior to the final three sessions. Two booster sessions were subsequently provided, and outcome was assessed at posttreatment and 1-month, 2-month, and 6-month follow-up assessments. The primary outcome was the degree of reduction in the Panic Disorder Severity Scale. Additional analyses examined the role of severity and current antidepressant or benzodiazepine use as moderators of DCS augmentation effects. RESULTS DCS augmentation resulted in significant benefit only early in the trial, with no beneficial effects of DCS augmentation evident at follow-up evaluations. We did not find that baseline severity or antidepressant or benzodiazepine use moderated DCS efficacy, but benzodiazepine use was associated with lower efficacy of CBT regardless of augmentation condition. CONCLUSIONS Consistent with other recent multicenter trials, the benefit of DCS was less than indicated by pilot study and reflected an acceleration of treatment response evident at treatment endpoint, but no advantage in response over follow-up evaluation. Our results did not support severity or concomitant medication moderators observed in previous trials of DCS augmentation.
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Affiliation(s)
- Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Mark H. Pollack
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Sheila M. Dowd
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Godfrey Pearlson
- Institute of Living and Yale University School of Medicine, Hartford, CT
| | - Kristin L. Szuhany
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - John. H. Krystal
- Department of Psychiatry, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT
| | - Naomi M. Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David F. Tolin
- Institute of Living and Yale University School of Medicine, Hartford, CT
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25
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Wolitzky-Taylor K, Zimmermann M, Arch JJ, De Guzman E, Lagomasino I. Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behav Res Ther 2015; 72:9-17. [DOI: 10.1016/j.brat.2015.06.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/16/2022]
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26
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Teng EJ, Barrera TL, Hiatt EL, Chaison AD, Dunn NJ, Petersen NJ, Stanley MA. Intensive weekend group treatment for panic disorder and its impact on co-occurring PTSD: A pilot study. J Anxiety Disord 2015; 33:1-7. [PMID: 25942646 DOI: 10.1016/j.janxdis.2015.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 03/30/2015] [Accepted: 04/13/2015] [Indexed: 01/18/2023]
Abstract
This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care.
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Affiliation(s)
- Ellen J Teng
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States; Center for Innovations in Quality, Effectiveness and Safety, United States; VA South Central Mental Illness Research, Education, and Clinical Center, United States.
| | - Terri L Barrera
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Emily L Hiatt
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Angelic D Chaison
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Nancy Jo Dunn
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Nancy J Petersen
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Center for Innovations in Quality, Effectiveness and Safety, United States; VA South Central Mental Illness Research, Education, and Clinical Center, United States
| | - Melinda A Stanley
- Michael E. DeBakey Veterans Affairs Medical Center, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States; Center for Innovations in Quality, Effectiveness and Safety, United States; VA South Central Mental Illness Research, Education, and Clinical Center, United States
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27
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Szuhany KL, Kredlow MA, Otto MW. Combination Psychological and Pharmacological Treatments for Panic Disorder. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.2.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Lutz W, Hofmann SG, Rubel J, Boswell JF, Shear MK, Gorman JM, Woods SW, Barlow DH. Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. J Consult Clin Psychol 2014; 82:287-97. [PMID: 24447004 PMCID: PMC3966935 DOI: 10.1037/a0035535] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recently, innovative statistical tools have been used to model patterns of change in psychological treatments. These tools can detect patterns of change in patient progress early in treatment and allow for the prediction of treatment outcomes and treatment length. METHOD We used growth mixture modeling to identify different latent classes of early change in patients with panic disorder (N = 326) who underwent a manualized cognitive-behavioral treatment. RESULTS Four latent subgroups were identified, showing clusters of change trajectories over the first 5 sessions. One of the subgroups consisted of patients whose symptoms rapidly decreased and also showed the best outcomes. This information improved treatment prediction by 16.1% over patient intake characteristics. Early change patterns also significantly predicted patients' early treatment termination. Patient intake characteristics that significantly predicted class membership included functional impairment and separation anxiety. CONCLUSIONS These findings suggest that early treatment changes are uniquely predictive of treatment outcome.
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Affiliation(s)
| | | | | | - James F Boswell
- Department of Psychology, University at Albany, State University of New York
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29
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Hofmann SG, Wu JQ, Boettcher H. Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: a meta-analysis. J Consult Clin Psychol 2014; 82:375-91. [PMID: 24447006 DOI: 10.1037/a0035491] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although cognitive-behavioral therapy (CBT) is effective for treating anxiety disorders, little is known about its effect on quality of life. To conduct a meta-analysis of CBT for anxiety disorders on quality of life, we searched for relevant studies in PubMed, PsycINFO, and the Cochrane Library and conducted manual searches. METHOD The search identified 44 studies that included 59 CBT trials, totaling 3,326 participants receiving CBT for anxiety disorders. We estimated the controlled and within-group random effects of the treatment changes on quality of life. RESULTS The pre-post within-group and controlled effect sizes were moderately strong (Hedges's g = 0.54 and Hedges's g = 0.56, respectively). Improvements were greater for physical and psychological domains of quality of life than for environmental and social domains. The overall effect sizes decreased with publication year and increased with treatment duration. Face-to-face treatments delivered individually and in groups produced significantly higher effect sizes than Internet-delivered treatments. CONCLUSION CBT for anxiety disorders is moderately effective for improving quality of life, especially in physical and psychological domains. Internet-delivered treatments are less effective than face-to-face treatments in improving quality of life.
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Affiliation(s)
| | - Jade Q Wu
- Department of Psychology, Boston University
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30
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Onken LS, Carroll KM, Shoham V, Cuthbert BN, Riddle M. Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health. Clin Psychol Sci 2014; 2:22-34. [PMID: 25821658 PMCID: PMC4374633 DOI: 10.1177/2167702613497932] [Citation(s) in RCA: 452] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present a vision of clinical science, based on a conceptual framework of intervention development endorsed by the Delaware Project. This framework is grounded in an updated stage model that incorporates basic science questions of mechanisms into every stage of clinical science research. The vision presented is intended to unify various aspects of clinical science toward the common goal of developing maximally potent and implementable interventions, while unveiling new avenues of science in which basic and applied goals are of equally high importance. Training in this integrated, translational model may help students learn how to conduct research in every domain of clinical science and at each stage of intervention development. This vision aims to propel the field to fulfill the public health goal of producing implementable and effective treatment and prevention interventions.
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31
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Baseline heartbeat perception accuracy and short-term outcome of brief cognitive-behaviour therapy for panic disorder with agoraphobia. Behav Cogn Psychother 2013; 43:426-35. [PMID: 24330918 DOI: 10.1017/s135246581300101x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Increased heartbeat perception accuracy (HBP-accuracy) may contribute to the pathogenesis of Panic Disorder (PD) without or with Agoraphobia (PDA). Extant research suggests that HBP-accuracy is a rather stable individual characteristic, moreover predictive of worse long-term outcome in PD/PDA patients. However, it remains still unexplored whether HBP-accuracy adversely affects patients' short-term outcome after structured cognitive behaviour therapy (CBT) for PD/PDA. AIM To explore the potential association between HBP-accuracy and the short-term outcome of a structured brief-CBT for the acute treatment of PDA. METHOD We assessed baseline HBP-accuracy using the "mental tracking" paradigm in 25 consecutive medication-free, CBT-naive PDA patients. Patients then underwent a structured, protocol-based, 8-session CBT by the same therapist. Outcome measures included the number of panic attacks during the past week, the Agoraphobic Cognitions Questionnaire (ACQ), and the Mobility Inventory-Alone subscale (MI-alone). RESULTS No association emerged between baseline HBP-accuracy and posttreatment changes concerning number of panic attacks. Moreover, higher baseline HBP-accuracy was associated with significantly larger reductions in the scores of the ACQ and the MI-alone scales. CONCLUSION Our results suggest that in PDA patients undergoing structured brief-CBT for the acute treatment of their symptoms, higher baseline HBP-accuracy is not associated with worse short-term outcome concerning panic attacks. Furthermore, higher baseline HBP-accuracy may be associated with enhanced therapeutic gains in agoraphobic cognitions and behaviours.
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Kushner MG, Maurer EW, Thuras P, Donahue C, Frye B, Menary KR, Hobbs J, Haeny AM, Van Demark J. Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: a randomized clinical trial. J Consult Clin Psychol 2013; 81:429-42. [PMID: 23276124 PMCID: PMC3756682 DOI: 10.1037/a0031301] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Treatment for alcohol use disorder (AUD) is far less effective for those with a co-occurring anxiety disorder. Surprisingly, adding an independent anxiety treatment to AUD treatment does not substantially improve the poor alcohol outcomes of these patients. This may reflect the lack of attention from independent treatments to the dynamic interaction of anxiety symptoms with alcohol use and drinking motivation. On the basis of this view, we assembled a cognitive behavioral therapy (CBT) program designed to both reduce anxiety symptoms and weaken the links between the experience of anxiety and the motivation to drink. METHOD 344 patients undergoing residential AUD treatment with current social phobia, generalized anxiety disorder, or panic disorder were randomly assigned to receive either the CBT or an active comparison treatment, progressive muscle relaxation training (PMRT). Assessments took place immediately following treatment and 4 months later (n = 247). RESULTS As predicted, the CBT group demonstrated significantly better alcohol outcomes 4 months following treatment than did the PMRT group. Although both groups experienced a substantial degree of anxiety reduction following treatment, there were no significant group differences immediately after treatment and only a slight advantage for the CBT group 4 months after treatment. CONCLUSIONS These findings suggest that specific interventions aimed at weakening the association between the experience of anxiety and drinking motivation play an important role in improving the alcohol outcomes of these difficult-to-treat patients beyond that of anxiety reduction alone.
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Affiliation(s)
- Matt G Kushner
- Department of Psychiary, University of Minnesota, MN 55454, USA.
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