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Partridge JA, Anton PM, Wallace JP, Lake LL. Exercise social support, barriers, and instructions in venous thromboembolism survivors: a descriptive study. Res Pract Thromb Haemost 2023; 7:102147. [PMID: 37601020 PMCID: PMC10439440 DOI: 10.1016/j.rpth.2023.102147] [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: 01/24/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Diagnosis of venous thromboembolism (VTE) can be a significant life event that leads to changes in physical activity and exercise. Currently, little is known about the psychosocial experiences of survivors including perceived sources of social support, exercise barriers, and instructions for exercise from medical providers. Objectives This study aimed to explore psychosocial characteristics associated with VTE survivors' postdiagnosis exercise. Specifically, 1) what are the main sources of social support utilized by VTE survivors for exercise, 2) what are the most significant exercise barriers (eg, physical, social, and psychological) faced by VTE survivors, and 3) what specific information relative to exercise is provided by medical professionals following diagnosis? Methods VTE survivors (n = 472) were recruited through social media groups to participate in open-ended questions about psychosocial characteristics pertaining to postdiagnosis exercise. Results VTE survivors reported multiple forms of exercise social support, although almost 1 in 4 participants reported having no support for exercise. Several postdiagnosis exercise barriers were noted, and the data indicated a wide variety of information from their medical providers regarding engaging in exercise following their diagnosis, suggesting that the unique benefits and drawbacks to these instructions should be examined in more detail. Conclusion Although VTE survivors identified numerous categories of social support, there also exist numerous barriers, including a lack of standardized instructions for exercise. Further exploration of these characteristics is needed to better serve this population to encourage postdiagnosis exercise.
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Affiliation(s)
| | - Philip M. Anton
- Southern Illinois University Carbondale, Carbondale, Illinois, USA
| | | | - Leslie L. Lake
- National Blood Clot Alliance, Philadelphia, Pennsylvania, USA
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Tremblay MA, Denis I, Turcotte S, DeGrâce M, Tully PJ, Foldes-Busque G. Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. J Clin Psychol Med Settings 2022; 30:28-42. [PMID: 35543901 PMCID: PMC9093559 DOI: 10.1007/s10880-022-09876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Abstract
Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials
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Affiliation(s)
- Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Michel DeGrâce
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Phillip J Tully
- Faculty of Health and Medical Sciences, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada. .,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada. .,Research Center of the Quebec Heart and Lung Institute, 2725, chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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3
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Farris SG, Kibbey MM. Be brave, BE-FIT! A pilot investigation of an ACT-informed exposure intervention to reduce exercise fear-avoidance in older adults. Cogn Behav Ther 2022; 51:273-294. [PMID: 35195055 DOI: 10.1080/16506073.2022.2037017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Exercise sensitivity, fear of physical sensations of exertion, is particularly elevated in individuals with cardiovascular disease and can promote fear-avoidance of physical activity. We developed an ACT-informed exposure intervention to target exercise sensitivity, called Behavioral Exposure For Interoceptive Tolerance (BE-FIT). In this Stage I pilot trial, we developed and evaluated the feasibility, safety, and initial efficacy of BE-FIT in low active patients with elevated exercise sensitivity enrolled in outpatient cardiac rehabilitation. BE-FIT is a 6-session, manualized, program-adjunctive treatment delivered during the initial weeks of cardiac rehabilitation and involves exposure to feared bodily sensations and exercise situations, bolstered by acceptance and values-focused processes. Patients (Mage = 70.7 years) were assigned to BE-FIT (n = 12) or an activity monitoring-only control (n = 7). Patients in the BE-FIT condition reported high satisfaction, completed 100% of sessions, and 86.3% (SD = 16.4%) of homework exposures. There were no adverse events reported. BE-FIT produced large-sized effects on reductions in exercise sensitivity and increases in both average steps/day and moderate-to-vigorous physical activity (MVPA) mins/day, from baseline to end-of-treatment. In contrast, the monitoring-only cohort evidenced small-sized reductions in exercise sensitivity and no change in average steps/day or MVPA mins/day. BE-FIT is safe, feasible, acceptable with promising findings from this Stage I trial.
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Affiliation(s)
- Samantha G Farris
- Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Mindy M Kibbey
- Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ 08854, USA
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4
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Tully PJ, Turnbull DA, Horowitz JD, Beltrame JF, Baune BT, Sauer-Zavala S, Baumeister H, Bean CG, Pinto RB, Cosh S, Wittert GA. Transdiagnostic Cognitive-Behavioral Therapy for Depression and Anxiety Disorders in Cardiovascular Disease Patients: Results From the CHAMPS Pilot-Feasibility Trial. Front Psychiatry 2022; 13:741039. [PMID: 35492726 PMCID: PMC9050199 DOI: 10.3389/fpsyt.2022.741039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/24/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aim of the Cardiovascular Health in Anxiety and Mood Problems Study (CHAMPS) is to pilot the Unified Protocol (UP) for the transdiagnostic treatment of depression and anxiety disorders in patients recently hospitalized for cardiovascular diseases (CVDs) and evaluate the feasibility. METHODS The present study is a controlled, block randomized pragmatic pilot-feasibility trial incorporating qualitative interview data, comparing UP (n = 9) with enhanced usual care (EUC, n = 10). Eligible trial participants had a recent CVD-cause admission and were above the severity threshold for depression or anxiety denoted by Patient Health Questionnaire (PHQ-9) total scores ≥10 and/or Generalized Anxiety Disorder (GAD-7) total scores ≥7 respectively on two occasions, and met criteria for one or more depression or anxiety disorders determined by structured clinical interview. Study outcomes were analyzed as intention-to-treat using linear mixed models and qualitative interview data were analyzed with content analysis. RESULTS Quantitative and qualitative measured indicated acceptability of the transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders. Satisfaction with UP was comparable to antidepressant therapy and higher than general physician counseling. However, there were difficulties recruiting participants with current disorders and distress on two occasions. The UP was associated with a reduction in total number of disorders determined by blinded raters. Linear mixed models indicated that a significantly greater reduction in anxiety symptoms was evident in the UP group by comparison to the EUC group (GAD-7, p between groups = 0.011; Overall Anxiety Severity and Impairment Scale, p between groups = 0.013). Results favored the UP group by comparison to EUC for change over 6 months on measures of physical quality of life and harmful alcohol use. There was no difference between the two groups on changes in depression symptoms (PHQ-9), stress, metacognitive worry beliefs, physical activity, or adherence. DISCUSSION In conclusion, this feasibility trial indicates acceptability of transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders that is tempered by difficulties with recruitment. Larger trials are required to clarify the efficacy of transdiagnostic depression and anxiety disorder CBT in populations with CVDs and depressive or anxiety disorders. CLINICAL TRIAL REGISTRATION https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12615000555550, identifier: ACTRN12615000555550.
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Affiliation(s)
- Phillip J Tully
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - John D Horowitz
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - John F Beltrame
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Christopher G Bean
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Ronette B Pinto
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Suzie Cosh
- School of Psychology, The University of New England, Armidale, NSW, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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5
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Carlucci L, Saggino A, Balsamo M. On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 87:101999. [PMID: 34098412 DOI: 10.1016/j.cpr.2021.101999] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
In recent years a large array of treatment protocols conceptualized as transdiagnostic have been developed with clinical and practical advantages compared to traditional single-disorder protocols. Within this panorama, the Transdiagnostic Unified Protocol (UP) of Emotional Disorders was developed aimed at treating the negative affective processes underlying several diagnostic categories, and accounting for the covariance of different emotional disorders. The UP has been found to efficiently target the roots of these disorders leading to a reduction in symptoms of co-occurring disorders. However, several questions have marginally addressed in the previous studies, and some UP features still remain unexplored. The present meta-analysis aims at evaluating whether the UP results to significant changes in anxiety and depression symptoms severity in children, adolescents, and adults. 19 RCTs and 13 uncontrolled pre-post trials comprising 2183 patients/clients met inclusion criteria for meta-analysis. Large to moderate combined overall effect size for both depression plus anxiety were detected in the uncontrolled pre-post studies (g = 0.756) and in RTCs studies (g = 0.452), respectively. Large effect size at pre-treatment to 3-6-month follow-up was observed for combined depression plus anxiety (g = 1.113). Subgroup analysis suggested that UP treatment does not differ across the anxiety and depression self-report measures. Moreover, UP intervention outperformed both passive and active control conditions to treat negative affective syndromes. Meta-regression confirmed the moderate effects of therapist level of experience, the sample characteristics, and the UP-protocol adaptations. The findings indicate that the manualized UP treatment has potential to contribute to improving mental health outcomes, particularly of anxiety and depression.
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Affiliation(s)
- Leonardo Carlucci
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy.
| | - Aristide Saggino
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
| | - Michela Balsamo
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
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6
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Anxiety Disorders in Late Life: Considerations for Assessment and Cognitive-Behavioral Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Tully PJ. Cognitive behavioural therapy for anxiety in cardiovascular diseases and implantable devices: A cautionary note. Eur J Prev Cardiol 2020; 27:2049. [DOI: 10.1177/2047487319888594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Alcántara C, Qian M, Meli L, Ensari I, Ye S, Davidson KW, Diaz KM. Anxiety Sensitivity and Physical Inactivity in a National Sample of Adults with a History of Myocardial Infarction. Int J Behav Med 2020; 27:520-526. [PMID: 32458220 DOI: 10.1007/s12529-020-09881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The psychological factors underlying physical inactivity in vulnerable cardiac adult populations remain understudied. Anxiety sensitivity, a cognitive vulnerability defined as fear of the physical, cognitive, and social consequences of anxiety, may be an important modifiable determinant of physical inactivity. We examined the association of anxiety sensitivity, and each anxiety sensitivity subscale (physical, cognitive, and social concerns), with physical inactivity in adults with a history of myocardial infarction (MI). METHODS Using cross-sectional data from a nationally representative survey of adults (N = 1417) in the USA who reported a health professional diagnosis of MI, we used weighted logistic regression models to evaluate the association between anxiety sensitivity (overall, and each subscale) and physical inactivity (self-reported exercise 0-1 day/week), with adjustment for age, gender, race, education, number of MIs, and depression. RESULTS Overall, 34.3% reported physical inactivity. Anxiety sensitivity was associated with greater odds of physical inactivity (OR = 1.01; 95% CI = 1.00, 1.02; p = .026). Of the subscales, only physical concerns were associated with physical inactivity (OR = 1.02; 95% CI = 1.01, 1.04; p = .008) in the final model. High vs. low fear of shortness of breath was most consistently associated with physical inactivity (OR = 1.49; 95% CI = 1.08, 2.06; p < .021). CONCLUSION Anxiety sensitivity, generally, and fear of the physical sensations of anxiety (i.e., "fear of shortness of breath"), specifically, are important correlates of physical inactivity in adults with a history of MI. Future research should replicate these findings and experimentally test whether cardiac rehabilitation interventions that include an adjunctive component targeting reduction of anxiety sensitivity overall, or specific somatic symptoms, improve physical activity in this population.
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Affiliation(s)
| | - Min Qian
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laura Meli
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ipek Ensari
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Karina W Davidson
- Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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9
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To make a run for IT - A feasibility study of ICBT combined with physical exercise for patients with panic disorder. Psychiatry Res 2020; 293:113381. [PMID: 32911348 DOI: 10.1016/j.psychres.2020.113381] [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: 02/28/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Guided Internet-based cognitive behavioural therapy (ICBT) is a recommended treatment for panic disorder promising to increase treatment availability, but there are some concerns regarding adherence, including adherence to the in vivo exposure given as home assignments. The aim of this study was to assess the feasibility of combining ICBT with physical exercise with the aim of improving adherence and treatment response to ICBT. METHOD 12 participants were included via routine clinical practice to an open pre- post trial of feasibility using ICBT and an aerobe exercise protocol. We used a mixed model design investigating multiple areas of adherence, participants' experience and clinical outcome. RESULTS 90.9% of the participants was considered completers in the ICBT program and the average adherence to the physical exercise was 93.1%. The experience of participating was summarized as "Hard work but worth it". Clinical outcomes effect sizes (d) ranged from 2.79 (panic severity) to .64 (Beck's anxiety index). CONCLUSION The sum results on adherence, qualitative and quantitative data all suggest that augmenting ICBT with an aerobic exercise protocol is feasible. We conclude that further research is warranted.
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10
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Cognitive behavioral therapy reduces illness perceptions and anxiety symptoms in patients with unruptured intracranial aneurysm. J Clin Neurosci 2020; 80:56-62. [PMID: 33099367 DOI: 10.1016/j.jocn.2020.07.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022]
Abstract
The main purpose of this study was to assess the relation between cognitive behavioral therapy and possible changes in illness perceptions and anxiety in patients diagnosed with unruptured intracranial aneurysm. An observational study of an intervention with 67 patients with an unruptured intracranial aneurysm from two medical centers in a Colombian city (n = 35 on the intervention group) was carried out. To assess changes, measurements were taken at baseline and at one-year follow-up with the Beck Anxiety Inventory and the Illness Perception Questionnaire, brief version, taking into account the importance of perceptions in the process of adjusting to illness and acquiring healthy life habits. Hypotheses were tested by a structural model. The results obtained from this study showed that illness perceptions were related to anxiety levels at both time points; however, the relations were stronger before cognitive behavioral therapy (βt0 = 0.61, p < 0.01; βt1 = 0.37, p < 0.01). Cognitive behavioral therapy was found to be a moderator of changes in both illness perceptions and anxiety at the time of follow-up (β = -0.31, p < 0.01; β = -0.26, p < 0.01). The structural model suggests that cognitive behavioral therapy is associated with less anxiety (β = -0.17, p < 0.05) and better illness perceptions (β = -0.35, p < 0.01) in patients diagnosed with unruptured intracranial aneurysms.
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11
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Farris SG, Abrantes AM, Bond DS, Stabile LM, Wu WC. Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation: PATIENT AND PRACTITIONER PERSPECTIVES. J Cardiopulm Rehabil Prev 2020; 39:E9-E13. [PMID: 30801438 DOI: 10.1097/hcr.0000000000000401] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE One unexplored mechanism for poor outcomes in cardiovascular and pulmonary rehabilitation (CVPR) is fear about aerobic exercise. Patients in CVPR may tend to avoid aerobic exercise because of the fear of physical sensations associated with exertion. This study examined fear about exercise in patients enrolled in outpatient CVPR and practitioner beliefs and behaviors related to fear associated with exercise. METHODS Survey data were collected from patients (n = 117) enrolled in cardiac rehabilitation (n = 69) and pulmonary rehabilitation (n = 48) and practitioners (n = 16) who were exercise physiologists and nurses working in CVPR. RESULTS Fears about exercise and avoidance behaviors were common among patients. In pulmonary rehabilitation, fears and avoidance of exercise were correlated with higher levels of anxiety and depression (r values = 0.27-0.54), lower forced expiratory volume in the first second of expiration/forced vital capacity (r values = -0.13 to -0.39), lower health-related quality of life (r values = -0.13 to -0.62), and stronger beliefs about utility of anxiety treatment (r values = 0.21-0.36). In cardiac rehabilitation, fears about exercise were correlated with higher levels of anxiety (r values = 0.19-0.38), lower mental health quality of life (r values = -0.25 to -0.27), and stronger beliefs about utility of anxiety treatment (r values = 0.30-0.40), and avoidance of exercise was correlated with lower exercise tolerance and poorer physical health quality of life (r values = -0.22 to -0.24). Practitioners estimated that an average of 47 ± 20% of patients experience fear associated with exercise and reported low feelings of preparedness to address patient anxiety and fear. CONCLUSIONS It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.
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Affiliation(s)
- Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey (Dr Farris); Departments of Psychiatry and Human Behavior (Drs Abrantes and Bond) and Medicine (Dr Wu), Alpert Medical School of Brown University, Providence, Rhode Island; Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, Rhode Island (Dr Abrantes); Weight Control and Diabetes Research Center (Dr Bond) and Center for Cardiac Fitness (Ms Stabile and Dr Wu), The Miriam Hospital, Providence, Rhode Island; Lifespan Cardiovascular Institute, Providence, Rhode Island (Dr Wu); and Department of Cardiology, Providence VA Medical Center, Providence, Rhode Island (Dr Wu)
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12
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Murphy B, Le Grande M, Alvarenga M, Worcester M, Jackson A. Anxiety and Depression After a Cardiac Event: Prevalence and Predictors. Front Psychol 2020; 10:3010. [PMID: 32063868 PMCID: PMC7000459 DOI: 10.3389/fpsyg.2019.03010] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Patients who are anxious or depressed after an acute cardiac event are at increased risk of a subsequent event and premature death. It is therefore important to identify these patients early in order to initiate supportive or even preventive measures. In the present study, we report on the prevalence of anxiety and depression during the first 12 months after an acute cardiac event, and the patient characteristics predictive of increased anxiety and depression risk in early and late convalescence. Methods We recruited a sample of 911 patients with acute myocardial infarction (AMI), acute coronary syndrome (ACS), and/or unstable angina (UA), and/or undergoing coronary artery bypass graft surgery (CABGS). Patients completed the Hospital Anxiety and Depression Scale (HADS) close to the time of their event, and again during early (2–4 months post-event) and late (6–12 months post-event) convalescence. Using HADS-A and HADS-D cut-offs of 8+, prevalence rates for anxiety, depression, and comorbid anxiety and depression were determined for each timepoint. Chi-square tests and odds ratios were used to identify baseline patient characteristics associated with increased anxiety and depression risk over 12 months. Results Anxiety rates were 43, 28, and 27% at the time of the event, early, and late convalescence. Depression rates were 22, 17, and 15%, respectively. Factors consistently associated with increased anxiety and depression risk were history of depression, financial strain, poor self-rated health, low socioeconomic status, younger age (<55 years), and smoking. Obesity, diabetes, and social isolation (living alone or being unpartnered) were identified as important albeit less significant risk factors. Neither sex nor event type were predictive of anxiety or depression. Conclusion This large patient sample provided the opportunity to identify rates of anxiety and depression during the 12 months after a cardiac event and key patient characteristics for increased risk. These risk factors are easily identifiable at the time of the event, and could be used to guide the targeting of support programs for patients at risk.
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Affiliation(s)
- Barbara Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia.,Department of Psychology, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Marlies Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Marian Worcester
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alun Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia.,Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong
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13
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Lim JA, Lee YI, Jang JH, Choi SH. Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder. Medicine (Baltimore) 2018; 97:e12422. [PMID: 30235717 PMCID: PMC6160091 DOI: 10.1097/md.0000000000012422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.
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Affiliation(s)
- Jae-A Lim
- Department of Psychiatry, Seoul National University Hospital
| | | | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Hospital
- Department of Medicine, Seoul National University College of Medicine
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital
- Department of Psychiatry and Institute of Human Behavioral Medicine in SNU-MRC, Seoul National University College of Medicine, Seoul, Republic of Korea
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14
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Westermair AL, Schaich A, Willenborg B, Willenborg C, Nitsche S, Schunkert H, Erdmann J, Schweiger U. Utilization of Mental Health Care, Treatment Patterns, and Course of Psychosocial Functioning in Northern German Coronary Artery Disease Patients with Depressive and/or Anxiety Disorders. Front Psychiatry 2018; 9:75. [PMID: 29593584 PMCID: PMC5858067 DOI: 10.3389/fpsyt.2018.00075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/23/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbid mental disorders in patients with coronary artery disease (CAD) are common and associated with adverse somatic outcomes. However, data on utilization rates of mental health care and treatment efficiency are scarce and inconsistent, which we tried to remedy with the present preliminary study on Northern German CAD patients. METHOD A total of 514 German CAD patients, as diagnosed by cardiac catheterization, were assessed using the Mini International Neuropsychiatric Interview and the Global Assessment of Functioning (GAF) scale. RESULTS Global utilization of mental health care since onset of CAD was 21.0%. Depressive disorders, younger age, and lower GAF at onset of CAD were associated with higher utilization rates, while anxiety disorders and gender were not. Lower GAF at onset of CAD, female gender, and psychotherapy was positively associated with higher gains in GAF, while younger age and anxiety disorders were negatively associated. CONCLUSION The majority of CAD patients with comorbid depression reported to have received mental health treatment and seemed to have benefited from it. However, we found preliminary evidence of insufficiencies in the diagnosis and treatment of anxiety disorders in CAD patients. Further studies, preferably prospective and with representative samples, are needed to corroborate or falsify these findings and explore possible further mediators of health-care utilization by CAD patients such as race, ethnicity, and socioeconomic status.
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Affiliation(s)
- Anna Lisa Westermair
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Anja Schaich
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Bastian Willenborg
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Christina Willenborg
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Stefan Nitsche
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.,Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Heribert Schunkert
- German Heart Center Munich, Technical University Munich, Munich, Germany.,Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany.,Partner Site Hamburg and Lübeck and Kiel, German Research Centre for Cardiovascular Research (DZHK), Lübeck, Germany.,University Heart Center Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
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15
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Abstract
Unrecognized anxiety is a difficult clinical presentation in cardiology. Anxiety leads to recurring emergency department visits and the need for numerous diagnostic evaluations to rule out cardiovascular disease (CVD). This review focuses broadly on anxiety and its subtypes in relation to the onset and progression of CVD while describing helpful guidelines to better identify and treat anxiety. Potential mechanisms of cardiopathogenesis are also described. An emerging literature demonstrates that anxiety disorders increase the risk for incident CVD but a causal relationship has not been demonstrated. Anxiety portends adverse prognosis in persons with established CVD that is independent from depression. The level of clinical priority received by depression should be extended to research and clinical intervention efforts in anxiety. Anxiety holds direct relevance for uncovering mechanisms of cardiopathogenesis, developing novel therapeutic strategies, and initiating clinical interventions in the population at risk of developing heart disease, or those already diagnosed with CVD.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France. .,Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia. .,INSERM U1219, Université de Bordeaux, 146 rue Léo Saignat - Case 11, 33076, Bordeaux Cedex, France.
| | - Nathan J Harrison
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, Australia.,Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Peter Cheung
- Department of Cardiology, The Queen Elizabeth Hospital, Woodville, Australia
| | - Suzanne Cosh
- Bordeaux Population Health, University of Bordeaux, U1219, Bordeaux, France
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