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Kyriakoulis P, Kyrios M. Biological and cognitive theories explaining panic disorder: A narrative review. Front Psychiatry 2023; 14:957515. [PMID: 36793941 PMCID: PMC9924294 DOI: 10.3389/fpsyt.2023.957515] [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] [Received: 05/31/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023] Open
Abstract
The current narrative review summarizes and examines several theories of panic disorder (PD) including biological theories, encompassing neurochemical factors, metabolic and genetic theories, respiratory and hyperventilation theories and cognitive theory. Biological theories have informed the development of psychopharmacological treatments; however, they may be limited in their utility given the efficacy of psychological treatments. In particular, behavioral and, more recently, cognitive models have garnered support due to the efficacy of cognitive-behavior therapy (CBT) in treating PD. The role of combination treatments has been found to be superior in the treatment of PD in particular cases, lending support for the need for an integrated approach and model for PD given that the etiology of PD is complex and multifactorial.
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Affiliation(s)
- Peter Kyriakoulis
- Faculty of Arts, Health and Design, Swinburne University, Hawthorn, VIC, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Órama Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, SA, Australia
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2
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Carpenter JK, Moskow DM, Hofmann SG. Enhanced Mental Reinstatement of Exposure to Improve Extinction Generalization: A Study on Claustrophobia and MRI Fear. Behav Ther 2023; 54:156-169. [PMID: 36608973 DOI: 10.1016/j.beth.2022.08.002] [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] [Received: 04/07/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
Fear of enclosed spaces prevents many people from receiving magnetic resonance imaging (MRI) scans. Although exposure therapy can effectively treat such fears, reductions in fear during exposure often do not generalize beyond the context in which they took place. This study tested a strategy designed to increase generalization, which involved revisiting the memory of a prior exposure to enhance retrieval of extinction learning. Forty-five participants with claustrophobia that included fear of MRI scans underwent a series of exposures lying inside a narrow cabinet. One week later, participants were randomly assigned to enhanced mental reinstatement (EMR) or control procedures. Prior to entering a mock MRI scanner, EMR participants recalled the memory of exposure training and listened to an audio recording of themselves describing what they learned, whereas control participants recalled a neutral memory. Compared to the control condition, EMR led to significantly reduced heart rate reactivity in the mock MRI scanner, but not self-reported fear or avoidance. There were no differences between conditions in claustrophobia symptoms or MRI fear at 1-month follow-up. Results suggest some benefits of mental reinstatement for improving generalization of gains following exposure training for claustrophobia, with measures of subjective fear and physiological arousal showing discordant outcomes.
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Affiliation(s)
- Joseph K Carpenter
- Boston University; National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division; VA Boston Healthcare System
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Lim WL, Tierney S. The Effectiveness of Positive Psychology Interventions for Promoting Well-being of Adults Experiencing Depression Compared to Other Active Psychological Treatments: A Systematic Review and Meta-analysis. JOURNAL OF HAPPINESS STUDIES 2022; 24:249-273. [PMID: 36373089 PMCID: PMC9638203 DOI: 10.1007/s10902-022-00598-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED This systematic review assesses if positive psychology interventions (PPI) are more effective than other active psychological interventions for increasing the well-being of depressed adults. A review of randomised trials that compared PPI to other active interventions was conducted. A systematic search was undertaken using PsycInfo, PubMed, EMBASE, Web of Science, Scopus, CINAHL, two trial registries, and a manual search. The outcomes were happiness and depression. Ten studies, totalling 1341 participants, were included in the review. The small effect sizes for depression (Hedge's g = 0.15) and happiness (Hedge's g = 0.20) favoured PPI but were not significant, indicating no difference between PPI and other active interventions for the outcomes. Heterogeneity was high mainly due to differences in trial implementation. Risks of bias ranged from moderate to high. The results should be interpreted with caution because of the small number of included studies, high heterogeneity, and presence of bias. Protocol Registration Number PROSPERO CRD42019152513. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10902-022-00598-z.
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Affiliation(s)
- Wei Loong Lim
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rukmini S, Sudhir PM, Bhaskar A, Arumugham SS. Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rimestad ML, O'Toole MS, Hougaard E. Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance. J Atten Disord 2020; 24:1966-1976. [PMID: 28971722 DOI: 10.1177/1087054717733043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The aim was to explore mediators of change in parent training (PT) for 3- to 8-year-old children with ADHD difficulties. Method: Parents of 64 children received PT with Incredible Years® and assessed child ADHD symptoms and conduct problems and their parenting strategies, parental self-efficacy, and therapeutic alliance before, during, and after PT. Product-of-coefficients mediation analyses in multilevel models were applied, and causal relations between mediators and outcome were investigated in time-lagged analyses. Results: Increased parental self-efficacy and reduced negative parenting statistically mediated reductions in ADHD and conduct problems in the product-of-coefficient analyses. However, time-lagged analyses were unable to detect a causal relation between prior change in mediators and subsequent child symptom reduction. There was limited evidence of therapeutic alliance as mediator of child symptom reduction or change in parenting variables. Conclusion: Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality.
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Shoji K, Smith AJ, Sano R, Samuelson KW, Benight CC. Social engagement, self-efficacy, and posttraumatic stress symptoms across 6 months of psychotherapy. J Clin Psychol 2020; 77:60-77. [PMID: 32761903 DOI: 10.1002/jclp.23034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/15/2020] [Accepted: 07/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The current study was conducted in a naturalistic treatment setting to examine whether and how perceptions about social engagement, trauma coping self-efficacy, and posttraumatic stress symptoms (PTS) influence one another across 6 months of psychotherapy for trauma survivors. METHOD The sample included 183 clients who reported exposure to traumatic events and significant PTS (PCL-5 ≥ 33). Participants (Mage = 37.8, 53.6% female) completed surveys at intake, 3 months, and 6 months into treatment. A cross-lagged panel analysis was used to test the relationships among perceived social engagement, coping self-efficacy, and PTS across three assessment points. RESULTS PTS at 3-months was a mediator in the relationship between intake perceived social engagement and 6-month coping self-efficacy and between intake perceived social engagement and 6-month perceived social engagement. CONCLUSIONS PTS several months into treatment may serve as a mechanism between intake perceived social engagement and functional outcomes such as coping self-efficacy.
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Affiliation(s)
- Kotaro Shoji
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Andrew J Smith
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Riko Sano
- Faculty of Nursing, Gifu University of Medical Science, Gifu, Japan
| | - Kristin W Samuelson
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Charles C Benight
- Trauma, Health, & Hazards Center, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA.,Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
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Solomonov N, Falkenström F, Gorman BS, McCarthy KS, Milrod B, Rudden MG, Chambless DL, Barber JP. Differential effects of alliance and techniques on Panic-Specific Reflective Function and misinterpretation of bodily sensations in two treatments for panic. Psychother Res 2020; 30:97-111. [PMID: 30821630 PMCID: PMC6778028 DOI: 10.1080/10503307.2019.1585591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022] Open
Abstract
ABSTRACTObjective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. Results: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. Conclusion: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.
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Affiliation(s)
- Nili Solomonov
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
- Weill Cornell Geriatric Psychiatry Institute, Weill Cornell Medical College, White Plains, NY
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Fredrik Falkenström
- Center for Clinical Research Sörmland and Department of Neuroscience, Uppsala University, Sweden
| | - Bernard S. Gorman
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
| | - Kevin S. McCarthy
- Chestnut Hill College, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara Milrod
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Marie G. Rudden
- Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | | | - Jacques P. Barber
- The Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY
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Breuninger C, Tuschen-Caffier B, Svaldi J. Dysfunctional cognition and self-efficacy as mediators of symptom change in exposure therapy for agoraphobia – Systematic review and meta-analysis. Behav Res Ther 2019; 120:103443. [DOI: 10.1016/j.brat.2019.103443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 07/02/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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Wesner AC, Behenck A, Finkler D, Beria P, Guimarães LSP, Manfro GG, Blaya C, Heldt E. Resilience and coping strategies in cognitive behavioral group therapy for patients with panic disorder. Arch Psychiatr Nurs 2019; 33:428-433. [PMID: 31280790 DOI: 10.1016/j.apnu.2019.06.003] [Citation(s) in RCA: 5] [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: 05/04/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although resilience and coping are important factors associated with mental health, they are rarely investigated in the treatment of patients with panic disorder (PD). OBJECTIVE To evaluate the response to four resilience and coping strategy sessions added to the standard cognitive behavioral group therapy (CBGT) protocol for PD. DESIGN Controlled clinical trial. METHODS The control group (n = 50) attended 12 CBGT sessions, while the intervention group (n = 50) received four additional resilience and coping strategy sessions, i.e., 16 in total. Symptom severity, resilience, coping strategies, and quality of life were assessed at baseline and post-CBGT. RESULTS Symptom severity and maladaptive coping strategies decreased significantly in both groups. However, the intervention group had increased resilience and improvement in the environment domain of quality of life. CONCLUSIONS Additional sessions have potential benefits for coping skills and resilience in PD patients, but these benefits should be evaluated in further long-term studies.
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Affiliation(s)
- Ana Cristina Wesner
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Andressa Behenck
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Débora Finkler
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Pedro Beria
- Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Gisele Gus Manfro
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Carolina Blaya
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil; Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elizeth Heldt
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil.
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Carpenter JK, Pinaire M, Hofmann SG. From Extinction Learning to Anxiety Treatment: Mind the Gap. Brain Sci 2019; 9:brainsci9070164. [PMID: 31336700 PMCID: PMC6680899 DOI: 10.3390/brainsci9070164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/27/2022] Open
Abstract
Laboratory models of extinction learning in animals and humans have the potential to illuminate methods for improving clinical treatment of fear-based clinical disorders. However, such translational research often neglects important differences between threat responses in animals and fear learning in humans, particularly as it relates to the treatment of clinical disorders. Specifically, the conscious experience of fear and anxiety, along with the capacity to deliberately engage top-down cognitive processes to modulate that experience, involves distinct brain circuitry and is measured and manipulated using different methods than typically used in laboratory research. This paper will identify how translational research that investigates methods of enhancing extinction learning can more effectively model such elements of human fear learning, and how doing so will enhance the relevance of this research to the treatment of fear-based psychological disorders.
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Affiliation(s)
- Joseph K Carpenter
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Megan Pinaire
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, 2nd floor, Boston, MA 02215, USA.
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Kealy D, Goodman G, Ogrodniczuk JS. Psychotherapists' ideals in the treatment of panic disorder: An exploratory study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017. [DOI: 10.1002/capr.12125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- David Kealy
- University of British Columbia; Vancouver BC Canada
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12
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Raknes S, Pallesen S, Bjaastad JF, Wergeland GJ, Hoffart A, Dyregrov K, Håland ÅT, Haugland BSM. Negative Life Events, Social Support, and Self-Efficacy in Anxious Adolescents. Psychol Rep 2017; 120:609-626. [PMID: 28558534 DOI: 10.1177/0033294117699820] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions. DESIGN Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). METHODS Based on scores from the Spence Children's Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety. RESULTS A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety. CONCLUSIONS The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interventions targeting anxious adolescents. We argue that addressing is the responsibility of not only the individual adolescents and their families but also schools, school health services, and policy makers. School-based interventions that increase social support and self-efficacy would probably be particularly beneficial for anxious adolescents.
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Affiliation(s)
- Solfrid Raknes
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jon Fauskanger Bjaastad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Center and Department of Psychology, University of Oslo, Oslo, Norway
| | - Kari Dyregrov
- Bergen University College, Faculty of Health and Social Sciences and Center for Crisis Psychology, Bergen, Norway
| | - Åshild Tellefsen Håland
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway
| | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health/University of Bergen, Bergen, Norway
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Lorenzo-Luaces L, Keefe JR, DeRubeis RJ. Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy. Behav Ther 2016; 47:785-803. [PMID: 27993333 DOI: 10.1016/j.beth.2016.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
Abstract
Since the introduction of Beck's cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.
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Chen MH, Tsai SJ. Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:219-26. [PMID: 26850787 DOI: 10.1016/j.pnpbp.2016.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Sandin B, Sánchez-Arribas C, Chorot P, Valiente RM. Anxiety sensitivity, catastrophic misinterpretations and panic self-efficacy in the prediction of panic disorder severity: Towards a tripartite cognitive model of panic disorder. Behav Res Ther 2015; 67:30-40. [DOI: 10.1016/j.brat.2015.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 01/18/2015] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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O'Toole MS, Mennin DS, Hougaard E, Zachariae R, Rosenberg NK. Cognitive and Emotion Regulation Change Processes in Cognitive Behavioural Therapy for Social Anxiety Disorder. Clin Psychol Psychother 2014; 22:667-76. [DOI: 10.1002/cpp.1926] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Mia S. O'Toole
- Department of Psychology and Behavioral Sciences; Aarhus University; Aarhus Denmark
| | - Douglas S. Mennin
- Department of Psychology, Hunter College; City University of New York; New York City NY USA
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences; Aarhus University; Aarhus Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioral Sciences; Aarhus University; Aarhus Denmark
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17
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Fentz HN, Arendt M, O'Toole MS, Hoffart A, Hougaard E. The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis. Behav Res Ther 2014; 60:23-33. [PMID: 25036540 DOI: 10.1016/j.brat.2014.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 05/08/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.
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Affiliation(s)
- Hanne N Fentz
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark.
| | - Mikkel Arendt
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark
| | - Mia S O'Toole
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark; Clinic for Anxiety Disorders and OCD, Aarhus University Hospital, Tretommervej 1, 8240 Risskov, Denmark
| | - Asle Hoffart
- Research Institute, Modum Bad, N-3370, Vikersund, Norway; Department of Psychology, University of Oslo, Norway
| | - Esben Hougaard
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Bartholins Alle' 9, 8000 Aarhus C, Denmark
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Aldao A, Jazaieri H, Goldin PR, Gross JJ. Adaptive and maladaptive emotion regulation strategies: interactive effects during CBT for social anxiety disorder. J Anxiety Disord 2014; 28:382-9. [PMID: 24742755 PMCID: PMC4089517 DOI: 10.1016/j.janxdis.2014.03.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/23/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
There has been a increasing interest in understanding emotion regulation deficits in social anxiety disorder (SAD; e.g., Hofmann, Sawyer, Fang, & Asnaani, 2012). However, much remains to be understood about the patterns of associations among regulation strategies in the repertoire. Doing so is important in light of the growing recognition that people's ability to flexibly implement strategies is associated with better mental health (e.g., Kashdan et al., 2014). Based on previous work (Aldao & Nolen-Hoeksema, 2012), we examined whether putatively adaptive and maladaptive emotion regulation strategies interacted with each other in the prediction of social anxiety symptoms in a sample of 71 participants undergoing CBT for SAD. We found that strategies interacted with each other and that this interaction was qualified by a three-way interaction with a contextual factor, namely treatment study phase. Consequently, these findings underscore the importance of modeling contextual factors when seeking to understand emotion regulation deficits in SAD.
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Affiliation(s)
- Amelia Aldao
- Psychology Department, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43215, United States.
| | - Hooria Jazaieri
- Institute of Personality and Social Research, Department of Psychology, University of California, Berkeley, 4152 Tolman Hall, Berkeley, CA 94720, United States.
| | - Philippe R Goldin
- Department of Psychology, Stanford University, Jordan Hall, Building 420, Stanford, CA 94305-2130, United States.
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA 94305-2130, United States.
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