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Rojas RL, Cremades CF, Celleri M, Garay CJ. Overall Anxiety Severity and Impairment Scale (OASIS) and Overall Depression Severity and Impairment Scale (ODSIS): Adaptation and Validation in Buenos Aires, Argentina. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e10451. [PMID: 37732148 PMCID: PMC10508253 DOI: 10.32872/cpe.10451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/15/2023] [Indexed: 09/22/2023] Open
Abstract
Background The OASIS and ODSIS scales are two transdiagnostic brief 5-item instruments designed to assess the severity and functional impairment associated with symptoms of anxiety and depression, respectively. The present study aimed to adapt and validate the online versions of both scales in Buenos Aires, Argentina. Method A sample of 344 women and men from the general population of Buenos Aires completed a test battery consisting of the OASIS, the ODSIS, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Positive and Negative Affect Scale (PANAS) and the Multicultural Quality of Life Index (MQLI). Descriptive statistics and item discrimination of both scales were analyzed, as well as their factorial structure, internal consistency, and convergent and discriminant validity, using the R programming language. Results The results showed a unidimensional factorial structure, excellent internal consistency, and adequate construct validity for both the OASIS and the ODSIS. Conclusion These results supports the use of both scales as valid and reliable instruments to assess severity and interference due to anxiety and depression in the general population of Buenos Aires, Argentina.
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Affiliation(s)
| | | | - Milagros Celleri
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
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2
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Hiller TS, Hoffmann S, Teismann T, Lukaschek K, Gensichen J. Psychometric evaluation and Rasch analyses of the German Overall Anxiety Severity and Impairment Scale (OASIS-D). Sci Rep 2023; 13:6840. [PMID: 37100805 PMCID: PMC10133318 DOI: 10.1038/s41598-023-33355-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that captures symptoms of anxiety and associated functional impairments. This study evaluates a German version (OASIS-D) that was administered to a convenience sample of 1398 primary care patients of whom 419 were diagnosed with panic disorder with/without agoraphobia. Psychometric properties were analyzed using classical test theory as well as probabilistic test theory. Factor analyses suggested a unitary (latent) factor structure. The internal consistency was good to excellent. Convergent as well as discriminant validity with other self-report measures was found. A sum score (range 0-20) of ≥ 8 emerged as optimal cut-score for screening purposes. A difference score of ≥ 5 was indicative of reliable individual change. A Rasch analysis of local item independence suggested response dependency between the first two items. Rasch analyses of measurement invariance detected noninvariant subgroups associated with age and gender. Analyses of validity and optimal cut-off score were solely based on self-report measures, which may have introduced method effects. In sum, the findings support the transcultural validity of the OASIS and indicate its applicability to naturalistic primary care settings. Caution is warranted when using the scale to compare groups that differ in age or gender.
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Affiliation(s)
- Thomas S Hiller
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstraße 9-13, 44787, Bochum, Germany
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, Nußbaumstr. 5, 80336, Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany.
- Institute of General Practice and Family Medicine, University Hospital of LMU Munich, Nußbaumstr. 5, 80336, Munich, Germany.
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3
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Takagishi Y, Ito M, Kanie A, Morita N, Makino M, Katayanagi A, Sato T, Imamura F, Nakajima S, Oe Y, Kashimura M, Kikuchi A, Narisawa T, Horikoshi M. Feasibility, acceptability, and preliminary efficacy of cognitive processing therapy in Japanese patients with posttraumatic stress disorder. J Trauma Stress 2023; 36:205-217. [PMID: 36514902 DOI: 10.1002/jts.22901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 12/15/2022]
Abstract
Cognitive processing therapy (CPT) is one of the most widely tested evidence-based treatments for posttraumatic stress disorder (PTSD). However, most studies on CPT have been conducted in Western cultural settings. This open-label, single-arm trial investigated the feasibility, acceptability, and preliminary efficacy of CPT for treating Japanese patients with PTSD. A total of 25 outpatients underwent 12 CPT sessions. The primary outcome was the assessment of PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV); secondary outcomes included the assessment of subjective PTSD severity, depressive and anxiety symptoms, trauma-related cognitions, and subjective quality of life. All outcomes were evaluated at pretreatment (i.e., baseline), posttreatment, and 6- and 12-month follow-ups. On average, participants attended 13 sessions of CPT (SD = 1.38), with a completion rate of 96.0%. One serious adverse event (hospitalization) occurred. Significant within-subjects standardized mean differences in CAPS-IV scores were found from baseline to treatment completion, g = -2.28, 95% CI [-3.00, -1.56]; 6-month follow-up, g = -2.95, 95% CI [-3.79, -2.12]; and 12-month follow-up, g = -2.15, 95% CI [-2.89, -1.41]. Moderate-to-large effects, gs = -0.77 to -2.45, were found on secondary outcomes. These findings support the feasibility, acceptability, and preliminary efficacy of CPT in a Japanese clinical setting.
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Affiliation(s)
- Yuriko Takagishi
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ayako Kanie
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuaki Morita
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Miyuki Makino
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akiko Katayanagi
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tamae Sato
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Fumi Imamura
- Department of Clinical Psychology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satomi Nakajima
- Faculty of Human Sciences, Musashino University, Tokyo, Japan
| | - Yuki Oe
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Akiko Kikuchi
- Faculty of Human Sciences, Musashino University, Tokyo, Japan
| | - Tomomi Narisawa
- Faculty of Human Sciences, Musashino University, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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4
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Noda S, Nishiuchi M, Shirotsuki K. Awareness and Acceptance in Anxiety‐Provoking Social Situations and Social Anxiety: Development and Initial Validation of the Social Anxiety‐Awareness and Acceptance Scale. JAPANESE PSYCHOLOGICAL RESEARCH 2023. [DOI: 10.1111/jpr.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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5
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Mikoska P, Novak L, Pilarik L, Bok T, Fulep M, Korinek R. A Czech version of the Overall Anxiety Severity and Impairment Scale (OASIS): standardization and psychometric properties. BMC Psychiatry 2022; 22:822. [PMID: 36564765 PMCID: PMC9782290 DOI: 10.1186/s12888-022-04365-5] [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: 04/22/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Overall Anxiety Severity and Impairment Scale (OASIS) is a transdiagnostic measure that assesses severity and impairment associated with anxiety disorders. However, its psychometric properties were primarily examined in English-speaking or western countries. Therefore, this study aims to examine its psychometric parameters in the Czech Republic. METHODS A large representative sample (n = 1738), a clinical sample (n = 57) and a retest sample (n = 20) were used. In addition to the OASIS, conventional measures of anxiety, depression, personality traits, self-esteem, life satisfaction, and other scales were also administered. Moreover, we examined the latent structure, reliability, validity, and the cut-off score for the Reliable Change Index (RCI) and the Clinically Significant Change Index (CSI). RESULTS Higher anxiety was found in females, religious non-church members, and students. The Confirmatory Factor Analysis supported the adequate fit of the unidimensional solution: x2(4) = 3.20; p < 0.525; CFI = 1.000; TLI = 1.000;RMSEA = 0, SRMR = 0. The measurement equivalence examination indicated that the OASIS measures anxiety invariantly between males and females. The validity of the OASIS was supported by positive associations with neuroticism, depression, perceived stress, guilt, shame, and the established anxiety measures. The internal consistency was excellent (Cronbach's alpha = 0.96, McDonald's omega = 0.96). The test-retest reliability was acceptable (r = 0.66). The cut-off for the CSI is 6 and the RCI is 5.32. CONCLUSIONS The OASIS represents a reliable and valid instrument for assessing anxiety in adults. Due to its shortness, excellent psychometric properties, and percentile norms, it is especially useful for short and accurate screening of anxiety and mapping therapeutic changes in clinical practice.
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Affiliation(s)
- Petr Mikoska
- grid.10979.360000 0001 1245 3953Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 244/22, 771 11, Olomouc, Czech Republic
| | - Lukas Novak
- Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 244/22, 771 11, Olomouc, Czech Republic. .,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Lubor Pilarik
- grid.24377.350000 0001 2359 0697Faculty of Education, Matej Bel University in Banská Bystrica, Banská Bystrica, Slovak Republic
| | - Tomas Bok
- grid.10979.360000 0001 1245 3953Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 244/22, 771 11, Olomouc, Czech Republic
| | - Martin Fulep
- grid.10979.360000 0001 1245 3953Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 244/22, 771 11, Olomouc, Czech Republic
| | - Richard Korinek
- grid.10979.360000 0001 1245 3953Olomouc University Social Health Institute, Palacky University in Olomouc, Univerzitni 244/22, 771 11, Olomouc, Czech Republic
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Maeda S, Sato T, Kanai Y, Blackie RA, Kocovski NL. Translation and Validation of the Japanese Version of the Trait and State
Post‐Event
Processing Inventory. JAPANESE PSYCHOLOGICAL RESEARCH 2022. [DOI: 10.1111/jpr.12322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Ishibashi S, Ide S, Suzuki F, Teo A, Nagata T, Kosaka H. Development of the Japanese version of the Coronavirus Anxiety Scale and Obsession with COVID-19 Scale. Psychiatry Clin Neurosci 2022; 76:124-125. [PMID: 35043511 DOI: 10.1111/pcn.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/10/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Saeko Ishibashi
- Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga-city, Japan.,University of Fukui Graduate School of Medical Sciences, Yoshida-gun, Japan
| | - Sohei Ide
- Center for Education in Liberal Arts and Sciences, Osaka University, Toyonaka, Japan
| | - Futoshi Suzuki
- Research Center for Child Mental Development, University of Fukui, Yoshida-gun, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Eiheiji-cho, Japan
| | - Alan Teo
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Hirotaka Kosaka
- Research Center for Child Mental Development, University of Fukui, Yoshida-gun, Japan.,Department of Neuropsychiatry, University of Fukui Hospital, Yoshida-gun, Japan
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Ritola V, Lipsanen JO, Pihlaja S, Gummerus EM, Stenberg JH, Saarni S, Joffe G. Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study. J Med Internet Res 2022; 24:e29384. [PMID: 35323119 PMCID: PMC8990365 DOI: 10.2196/29384] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients.
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Affiliation(s)
- Ville Ritola
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jari Olavi Lipsanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Satu Pihlaja
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero-Matti Gummerus
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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9
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Comer JS, Conroy K, Cornacchio D, Furr JM, Norman SB, Stein MB. Psychometric evaluation of a caregiver-report adaptation of the Overall Anxiety Severity and Impairment Scale (OASIS) for use with youth populations. J Affect Disord 2022; 300:341-348. [PMID: 34979182 PMCID: PMC8828693 DOI: 10.1016/j.jad.2021.12.113] [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: 07/22/2021] [Revised: 11/24/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Abstract
Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N = 132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring.
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Affiliation(s)
- Jonathan S. Comer
- Center for Children and Families, Department of Psychology, Florida International University
| | - Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University
| | | | - Jami M. Furr
- Center for Children and Families, Department of Psychology, Florida International University
| | - Sonya B. Norman
- Department of Psychiatry, University of California, San Diego
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego
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Osma J, Martínez-Loredo V, Díaz-García A, Quilez-Orden A, Peris-Baquero Ó. Spanish Adaptation of the Overall Anxiety and Depression Severity and Impairment Scales in University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:345. [PMID: 35010602 PMCID: PMC8750775 DOI: 10.3390/ijerph19010345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 12/25/2021] [Indexed: 06/14/2023]
Abstract
The lifetime prevalence of emotional disorders in Spain is 4.1% for anxiety and 5.2% for depression, increasing among university students. Considering the scarcity of screenings with adequate psychometric properties, this study aims to explore the validity evidence of the Overall Anxiety/Depression Severity and Impairment Scales (OASIS and ODSIS). A total of 382 university students from the general population were assessed on anxiety and depressive symptoms, as well as quality of life. The one-dimensional structure of both the OASIS and ODSIS explained 87.53% and 90.60% of variance, with excellent internal consistency (α = 0.94 and 0.95, respectively) and optimal cut-offs of 4 and 5, respectively. Both scales show a significant moderate association with other measures of anxiety, depression and quality of life. The OASIS and ODSIS have shown good reliability and sound validity evidence that recommend their use for the assessment and early detection of anxiety and depressive symptoms, and associated quality of life impairment in Spanish youth.
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Affiliation(s)
- Jorge Osma
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain; (V.M.-L.); (A.D.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain
| | - Víctor Martínez-Loredo
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain; (V.M.-L.); (A.D.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain
| | - Amanda Díaz-García
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain; (V.M.-L.); (A.D.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain
| | - Alba Quilez-Orden
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain; (V.M.-L.); (A.D.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain
- Unidad de Salud Mental Moncayo, 50500 Tarazona, Spain
| | - Óscar Peris-Baquero
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain; (V.M.-L.); (A.D.-G.); (A.Q.-O.); (Ó.P.-B.)
- Instituto de Investigación Sanitaria de Aragón, 50009 Zaragoza, Spain
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Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111644. [PMID: 34770156 PMCID: PMC8582839 DOI: 10.3390/ijerph182111644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The efficacy of the Unified Protocol (UP), a transdiagnostic cognitive-behavioral therapy, with trauma-focused exposure has not been sufficiently demonstrated for post-traumatic stress disorder (PTSD) with multiple comorbidities. This study examined the effects of UP treatment with trauma-focused exposure on symptoms of PTSD and comorbidities in a client who was hesitant about exposure. (2) Methods: The client, who had comorbid dysthymia, social anxiety disorder, agoraphobia, and bulimia nervosa, participated in the UP for 20 sessions over 6 months. The principal diagnosis and symptoms of the comorbid disorders were assessed at baseline, post-intervention, and at the 3-month follow-up. This treatment was conducted as part of a clinical study (UMIN000008322). (3) Results: The client showed improvement in the principal diagnosis and symptoms of the comorbid disorders post-intervention compared with baseline and no longer met the diagnostic criteria for any of the disorders. Considerable symptom improvement was observed with imaginal exposure to trauma memories. (4) Conclusions: The UP was an effective alternative treatment for PTSD and symptoms of comorbidities in this client who was hesitant about exposure to traumatic memories, and that the inclusion of trauma-focused exposure provided sufficient therapeutic effects. Further research is needed to examine the generalizability of our findings.
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12
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Sandora J, Novak L, Brnka R, van Dijk JP, Tavel P, Malinakova K. The Abbreviated Overall Anxiety Severity and Impairment Scale (OASIS) and the Abbreviated Overall Depression Severity and Impairment Scale (ODSIS): Psychometric Properties and Evaluation of the Czech Versions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10337. [PMID: 34639633 PMCID: PMC8508516 DOI: 10.3390/ijerph181910337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 01/20/2023]
Abstract
Short and effective tools for measuring depression, anxiety and their resulting impairments are lacking in the Czech language. The abbreviated versions of the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS) show very good psychometric properties in English and other languages, and can be used in different settings for research or clinical purposes. The aim of this study was the psychometric evaluation and validation of the Czech versions of the abbreviated forms of both tools in the general population. A nationally representative sample of 2912 participants (age = 48.88, SD = 15.56; 55% female) was used. The non-parametric testing of the differences between sociodemographic groups revealed a higher level of anxiety and depression in students, females and religious respondents. Confirmatory Factor Analysis suggested a good fit for the unidimensional model of the OASIS: x2(4) = 38.28; p < 0.001; TLI = 0.999; CFI = 0.997; RMSEA = 0.078; SRMR = 0.027 and the ODSIS: x2(4) = 36.54; p < 0.001; TLI = 0.999; CFI = 0.999; RMSEA = 0.076; SRMR = 0.021 with the data. Both scales had an excellent internal consistency (OASIS: Cronbach's alpha = 0.95, McDonald's omega = 0.95 and ODSIS: Cronbach's alpha = 0.95, McDonald's omega = 0.95). A clinical cut-off of 15 was identified for the OASIS and a cut-off of 12 for the ODSIS. The study showed good validity for both scales. The Czech versions of the abbreviated OASIS and ODSIS were short and valid instruments for measuring anxiety and depression.
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Affiliation(s)
- Jan Sandora
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
| | - Lukas Novak
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
| | - Robert Brnka
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
- First Department of Internal Medicine, Faculty of Medicine, Comenius University Bratislava, 813 72 Bratislava, Slovakia
| | - Jitse P. van Dijk
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, 040 11 Kosice, Slovakia
| | - Peter Tavel
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
| | - Klara Malinakova
- Olomouc University Social Health Institute, Palacky University Olomouc, 771 11 Olomouc, Czech Republic; (L.N.); (R.B.); (J.P.v.D.); (P.T.); (K.M.)
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13
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Kashihara J, Takebayashi Y, Kunisato Y, Ito M. Classifying patients with depressive and anxiety disorders according to symptom network structures: A Gaussian graphical mixture model-based clustering. PLoS One 2021; 16:e0256902. [PMID: 34469469 PMCID: PMC8409670 DOI: 10.1371/journal.pone.0256902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022] Open
Abstract
Patients with mental disorders often suffer from comorbidity. Transdiagnostic understandings of mental disorders are expected to provide more accurate and detailed descriptions of psychopathology and be helpful in developing efficient treatments. Although conventional clustering techniques, such as latent profile analysis, are useful for the taxonomy of psychopathology, they provide little implications for targeting specific symptoms in each cluster. To overcome these limitations, we introduced Gaussian graphical mixture model (GGMM)-based clustering, a method developed in mathematical statistics to integrate clustering and network statistical approaches. To illustrate the technical details and clinical utility of the analysis, we applied GGMM-based clustering to a Japanese sample of 1,521 patients (Mage = 42.42 years), who had diagnostic labels of major depressive disorder (MDD; n = 406), panic disorder (PD; n = 198), social anxiety disorder (SAD; n = 116), obsessive-compulsive disorder (OCD; n = 66), comorbid MDD and any anxiety disorder (n = 636), or comorbid anxiety disorders (n = 99). As a result, we identified the following four transdiagnostic clusters characterized by i) strong OCD and PD symptoms, and moderate MDD and SAD symptoms; ii) moderate MDD, PD, and SAD symptoms, and weak OCD symptoms; iii) weak symptoms of all four disorders; and iv) strong symptoms of all four disorders. Simultaneously, a covariance symptom network within each cluster was visualized. The discussion highlighted that the GGMM-based clusters help us generate clinical hypotheses for transdiagnostic clusters by enabling further investigations of each symptom network, such as the calculation of centrality indexes.
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Affiliation(s)
- Jun Kashihara
- Department of Social Psychology, Faculty of Sociology, Toyo University, Tokyo, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshihiko Kunisato
- Department of Psychology, School of Human Sciences, Senshu University, Kawasaki, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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14
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Hilden HM, Rosenström T, Karila I, Elokorpi A, Torpo M, Arajärvi R, Isometsä E. Effectiveness of brief schema group therapy for borderline personality disorder symptoms: a randomized pilot study. Nord J Psychiatry 2021; 75:176-185. [PMID: 33103925 DOI: 10.1080/08039488.2020.1826050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). METHODS Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. RESULTS Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. LIMITATIONS Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. CONCLUSIONS Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.
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Affiliation(s)
- Hanna-Mari Hilden
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Aila Elokorpi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mirka Torpo
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva Arajärvi
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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15
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Kim SH, Park K, Yoon S, Choi Y, Lee SH, Choi KH. A Brief Online and Offline (Paper-and-Pencil) Screening Tool for Generalized Anxiety Disorder: The Final Phase in the Development and Validation of the Mental Health Screening Tool for Anxiety Disorders (MHS: A). Front Psychol 2021; 12:639366. [PMID: 33692730 PMCID: PMC7937919 DOI: 10.3389/fpsyg.2021.639366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 12/04/2022] Open
Abstract
Generalized anxiety disorder (GAD) can cause significant socioeconomic burden and daily life dysfunction; hence, therapeutic intervention through early detection is important. This study was the final stage of a 3-year anxiety screening tool development project that evaluated the psychometric properties and diagnostic screening utility of the Mental Health Screening Tool for Anxiety Disorders (MHS: A), which measures GAD. A total of 527 Koreans completed online and offline (i.e., paper-and pencil) versions of the MHS: A, Beck Anxiety Inventory (BAI), Generalized Anxiety Disorder-7 (GAD-7), and Penn State Worry Questionnaire (PSWQ). The participants had an average age of 38.6 years and included 340 (64.5%) females. Participants were also administered the Mini-International Neuropsychiatric Interview (MINI). Internal consistency, convergent/criterion validity, item characteristics, and test information were assessed based on the item response theory (IRT), and a factor analysis and cut-off score analyses were conducted. The MHS: A had good internal consistency and good convergent validity with other anxiety scales. The two versions (online/offline) of the MHS: A were nearly identical (r = 0.908). It had a one-factor structure and showed better diagnostic accuracy (online/offline: sensitivity = 0.98/0.90, specificity = 0.80/0.83) for GAD detection than the GAD-7 and BAI. The IRT analysis indicated that the MHS: A was most informative as a screening tool for GAD. The MHS: A can serve as a clinically useful screening tool for GAD in Korea. Furthermore, it can be administered both online and offline and can be flexibly used as a brief mental health screener, especially with the current rise in telehealth.
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Affiliation(s)
- Shin-Hyang Kim
- School of Psychology, Korea University, Seoul, South Korea.,KU Mind Health Institute, Korea University, Seoul, South Korea
| | - Kiho Park
- School of Psychology, Korea University, Seoul, South Korea.,KU Mind Health Institute, Korea University, Seoul, South Korea
| | - Seowon Yoon
- School of Psychology, Korea University, Seoul, South Korea
| | - Younyoung Choi
- Department of Adolescent Psychology, Hanyang Cyber University, Seoul, South Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsanpaik Hospital, Goyang, South Korea
| | - Kee-Hong Choi
- School of Psychology, Korea University, Seoul, South Korea.,KU Mind Health Institute, Korea University, Seoul, South Korea
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16
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Imai H, Takamatsu T, Mitsuya H, Yoshizawa H, Mitsuya H, Furukawa TA. The Characteristics and Social Functioning of Pathological Social Withdrawal, "Hikikomori," in a Secondary Care Setting: a One-Year Cohort Study. BMC Psychiatry 2020; 20:352. [PMID: 32631267 PMCID: PMC7336612 DOI: 10.1186/s12888-020-02660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathological social withdrawal, named "Hikikomori," is a Japanese culture-bound syndrome and a serious social problem in Japan. The number of Hikikomori cases in Japan was estimated at about 563,000 in 2016 according to governmental surveys. However, no studies have reported how many people with Hikikomori have access to community-based psychiatry clinics, and how different they are from non-Hikikomori patients regarding their baseline characteristics and outcomes. The aim of the present study is to evaluate the baseline characteristics, clinical attendance, and social functioning of community psychiatric clinic patients treated for social withdrawal at one-year follow-up. METHOD Participants (n = 304) were all patients (aged under 65) of a psychiatric clinic in a one-year period. Baseline patient characteristics were compared among "current" Hikikomori patients, "past" Hikikomori," and "other" patients. Logistic regression analysis of clinic attendance status and social functioning at one-year follow-up was used to assess patient outcomes. Independent variables were age, gender, Hikikomori status, and support from clinical staff. RESULTS Numbers of "current", "past" Hikikomori, and "other" patients were 60 (19.7%), 81 (26.6%), and 163 (53.6%), respectively. The percentage of "current" Hikikomori who attended in person (56.7%) was significantly smaller than for "past" (92.6%) and "other" (92.6) (p < .001). The age distribution of "current" Hikikomori patients was bimodal, peaking at 20 and 40-45 years. The "current" state predicted significantly fewer regular visits (OR = 0.43; 95% CI = 0.22-0.83; p = .012); support from psychiatric social workers increased visits (OR = 2.35; 95% CI = 1.14-4.86; p = .021). Among the "current" Hikikomori patients, first visit attendance in person predicted regular attendance; no factor consistently predicted working/schooling status. CONCLUSION A sizable percentage of community clinic patients experienced Hikikomori. The "current" Hikikomori state corresponded with low clinic attendance and social function; "support from clinical staff" may increase visit regularity; no factors consistently improved social functioning. Further multi-site study is warranted to examine the generalizability of the findings from the current single-center study.
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Affiliation(s)
- Hissei Imai
- Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. .,Ohashi Psychiatric Clinic, Kyoto, Japan.
| | | | | | | | | | - Toshi A. Furukawa
- grid.258799.80000 0004 0372 2033Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
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17
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Takagaki K, Ito M, Takebayashi Y, Nakajima S, Horikoshi M. Roles of Trait Mindfulness in Behavioral Activation Mechanism for Patients With Major Depressive Disorder. Front Psychol 2020; 11:845. [PMID: 32411066 PMCID: PMC7202344 DOI: 10.3389/fpsyg.2020.00845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/06/2020] [Indexed: 01/04/2023] Open
Abstract
Behavioral activation and mindfulness have both been shown to engender improvement of functional impairment in patients with major depressive disorder. In behavioral activation, the practice of engaging with the direct experience of the present moment is central, especially when targeting avoidance. Consequently, mindfulness affects changes of avoidance in behavioral activation. This study was designed to assess exploratory relations among trait mindfulness, avoidance, and functional impairment in behavioral activation mechanism for depression. For 1042 participants with depression only or for depression with anxiety disorders, we used structural equation modeling to examine relations among trait mindfulness, avoidance, and functional impairment. Trait mindfulness non-reactivity, non-judging, and acting with awareness had a direct negative effect on avoidance. Trait mindfulness non-reactivity, trait non-judging, and trait acting with awareness had indirect negative effects on functional impairment. Results show that each trait mindfulness facet exhibited a distinct pattern of relations with avoidance and impairment.
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Affiliation(s)
- Koki Takagaki
- Health Service Center, Hiroshima University, Hiroshima, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shun Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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18
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Grech M, Turnbull DA, Wittert GA, Tully PJ. Identifying the Internalizing Disorder Clusters Among Recently Hospitalized Cardiovascular Disease Patients: A Receiver Operating Characteristics Study. Front Psychol 2020; 10:2829. [PMID: 31920862 PMCID: PMC6929587 DOI: 10.3389/fpsyg.2019.02829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Depression and anxiety disorders are common among cardiovascular disease (CVD) populations, leading several cardiology societies to recommend routine screening to streamline psychological interventions. However, it remains poorly understood whether routine screening in CVD populations identifies the broader groups of disorders that cluster together within individuals, known as anxious-misery and fear. This study examines the screening utility of four anxiety and depression questionnaires to identify the two internalizing disorder clusters; anxious-misery and fear. Patients with a recent hospital admission for CVD (n = 85, 69.4% males) underwent a structured clinical interview with the MINI International Neuropsychiatric Interview. The participants also completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Overall Anxiety Severity Impairment Scale (OASIS), and the stress subscale of the Depression Anxiety Stress Scale (DASS). The PHQ-9 and the GAD-7 yielded appropriate screening properties to detect three different iterations of the anxious-misery cluster (sensitivity >80.95% and specificity >82.81%). The GAD-7 was the only instrument to display favorable screening properties to detect a fear cluster omitting post-traumatic stress disorder (PTSD) but including obsessive-compulsive disorder (OCD; sensitivity 81.25%, specificity 76.81%). These findings indicate that the PHQ-9 and GAD-7 could be implemented to reliably screen for anxious-misery disorders among CVD in-patients, however, the receiver operating characteristics (ROC) to detect fear disorders were contingent on the placement of PTSD and OCD within clusters. The findings are discussed in relation to routine screening guidelines in CVD populations and contemporary understandings of the internalizing disorders.
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Affiliation(s)
- Megan Grech
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Phillip J Tully
- Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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19
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Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales. J Affect Disord 2019; 252:9-18. [PMID: 30953927 DOI: 10.1016/j.jad.2019.03.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anxiety and depressive disorders are the most frequent disorders for which patients seek care in public health settings in Spain. This study aimed at validating the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), which are brief screening scales for anxiety and depression consisting of only five items each. METHODS The study was conducted in a Spanish clinical sample receiving outpatient mental health treatment (N = 339). A subsample of participants (n = 219) was assessed before and after receiving a course of cognitive-behavioral treatment. RESULTS The results revealed excellent internal consistency estimates (Cronbach's alpha for the OASIS and the ODSIS was 0.87 and 0.94, respectively), along with promising convergent and discriminant validity and test-criterion relationships (i.e., moderate correlation with other measures of depression and anxiety, as well as with neuroticism, quality of life, adjustment, and negative affect). A one-dimensional structure was obtained for the OASIS and the ODSIS. The ROC analyses indicated an area under the curve of 0.83 for the OASIS and the ODSIS when predicting moderate-to-severe anxiety and depression, respectively. Good sensitivity to therapeutic change was also evidence and the analysis of the sensitivity as a function of 1-specificity area suggested a cutoff value of 10 for both scales. LIMITATIONS Inter-rater reliability of diagnoses with the ADIS-IV interview could not be investigated and the results obtained may not be generalizable to other samples and health settings. CONCLUSIONS The availability of these two short and psychometrically sound measures should make screening of anxiety and depressive symptoms in routine care more feasible.
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20
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González-Robles A, Mira A, Miguel C, Molinari G, Díaz-García A, García-Palacios A, Bretón-López JM, Quero S, Baños RM, Botella C. A brief online transdiagnostic measure: Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among Spanish patients with emotional disorders. PLoS One 2018; 13:e0206516. [PMID: 30383797 PMCID: PMC6211825 DOI: 10.1371/journal.pone.0206516] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/15/2018] [Indexed: 11/19/2022] Open
Abstract
The Overall Anxiety Severity and Impairment Scale (OASIS) is a self-report questionnaire designed to evaluate the severity and functional impairment associated with anxiety. Given its transdiagnostic nature, it can be used indistinctly across anxiety and depressive disorders. In this study, the psychometric properties of the online version of the OASIS were evaluated in a Spanish clinical sample with emotional disorders. Patients (n = 583) with anxiety (n = 250) and depression (n = 333) with a mean age of 37.21 (SD = 12.22), underwent a diagnostic interview and questionnaires assessing anxiety, depression, positive and negative affect, and quality of life. Factorial structure, internal consistency, convergent and discriminant validity, cutoff scores, and sensitivity to change were analyzed. Confirmatory Factor Analysis yielded a unidimensional factor structure, consistent with previous validations of the instrument. The analyses showed good internal consistency and adequate convergent and discriminant validity, as well as sensitivity to change. A cutoff score of 7.5 was found to meet the criteria used in this study to select the optimal cutoff point. Overall, in this study, the psychometric properties of the online version of the OASIS were found to be appropriate. The brevity and ease of use of the OASIS support its adequacy as a valid measure of anxiety severity and impairment in Spanish clinical samples with anxiety and depression.
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Affiliation(s)
- Alberto González-Robles
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Adriana Mira
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Clara Miguel
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Guadalupe Molinari
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Amanda Díaz-García
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana M. Bretón-López
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Soledad Quero
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Rosa M. Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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21
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Doi S, Ito M, Takebayashi Y, Muramatsu K, Horikoshi M. Factorial Validity and Invariance of the 7-Item Generalized Anxiety Disorder Scale (GAD-7) Among Populations With and Without Self-Reported Psychiatric Diagnostic Status. Front Psychol 2018; 9:1741. [PMID: 30283386 PMCID: PMC6157449 DOI: 10.3389/fpsyg.2018.01741] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 08/28/2018] [Indexed: 11/13/2022] Open
Abstract
The 7-item Generalized Anxiety Disorder Scale (GAD-7) is commonly used to monitor anxiety symptoms. However, its factor structure has been inconsistent among competing models: unidimensional, two-dimensional, or higher order models. Additionally, it is unknown whether the scale has measurement invariance between populations with and without self-reported psychiatric diagnostic status. Participants were Japanese adults with self-reported anxiety disorder (AD; n = 479), self-reported AD and major depressive disorder (MDD; n = 314), or without self-reported psychiatric diagnostic status (self-reported non-MDD/AD; n = 654), who completed this questionnaire on the Internet. Confirmatory factor analyses showed the higher order model had similar fit indices to the unidimensional and two-dimensional factor models. For the higher order model of GAD-7, metric invariance was supported between the self-reported non-MDD/AD and self-reported AD status groups, and scalar invariance was supported between the self-reported AD status and self-reported AD with MDD status groups. Moreover, convergent and discriminant validity were consistent with previous findings in Western cultures. These results suggest that factor loadings are equivalent and the construct has the same meaning between the self-reported non-MDD/AD and self-reported AD status groups, and the total or sub-scale scores were comparable between self-reported AD status and self-reported AD with MDD status groups. The major limitation of this study is that the participants' diagnoses were self-reported, not confirmed by clinical structured interview. Further studies that incorporate clinical structured interviews are needed.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kumiko Muramatsu
- Graduate School of Clinical Psychology, Niigata Seiryo University, Niigata, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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22
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Doi S, Ito M, Takebayashi Y, Muramatsu K, Horikoshi M. Factorial validity and invariance of the Patient Health Questionnaire (PHQ)-9 among clinical and non-clinical populations. PLoS One 2018; 13:e0199235. [PMID: 30024876 PMCID: PMC6053131 DOI: 10.1371/journal.pone.0199235] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/23/2018] [Indexed: 11/21/2022] Open
Abstract
The Patient Health Questionnaire-9 (PHQ-9) is commonly used to screen for depressive disorder and for monitoring depressive symptoms. However, there are mixed findings regarding its factor structure (i.e., whether it has a unidimensional, two-dimensional, or bi-factor structure). Furthermore, its measurement invariance between non-clinical and clinical populations and that between patients with major depressive disorder (MDD) and MDD with comorbid anxiety disorder (AD) is unknown. Japanese adults with MDD (n = 406), MDD with AD (n = 636), and no psychiatric disorders (non-clinical population; n = 1,163) answered this questionnaire on the Internet. Confirmatory factor analyses showed that the bi-factor model had a better fit than the unidimensional and two-dimensional factor models did. The results of a multi-group confirmatory factor analysis indicated scalar invariance between the non-clinical and only MDD groups, and that between the only MDD and MDD with AD groups. In conclusion, the bi-factor model with two specific factors was supported among the non-clinical, only MDD, and MDD with AD groups. The scalar measurement invariance model was supported between the groups, which indicated the total or sub-scale scores were comparable between groups.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- National Center of Neurology and Psychiatry, National Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
- * E-mail:
| | - Masaya Ito
- National Center of Neurology and Psychiatry, National Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center of Neurology and Psychiatry, National Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
| | - Kumiko Muramatsu
- Graduate School of Clinical Psychology, Niigata Seiryo University, Niigata, Japan
| | - Masaru Horikoshi
- National Center of Neurology and Psychiatry, National Center for Cognitive Behavior Therapy and Research, Tokyo, Japan
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23
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Wurm M, Klein Strandberg E, Lorenz C, Tillfors M, Buhrman M, Holländare F, Boersma K. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interv 2017; 10:54-64. [PMID: 30135753 PMCID: PMC6084869 DOI: 10.1016/j.invent.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/06/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimal treatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarching aim of this study was to test an internet delivered therapist guided transdiagnostic treatment with telephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of Emotional Disorders was used as an intervention for pain patients with residual pain problems and comorbid emotional problems after having received a multimodal pain rehabilitation. The study used a replicated AB single case experimental design (N = 5; 3 females). Outcome measures were depressive and general anxiety symptoms, pain intensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) and patient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety for three participants and a decrease of depression for four participants. Decreases were small and did not always reach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two out of four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnostic criteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patient satisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support may be a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, the effects are unclear. The gap between high patient satisfaction and small changes in symptomatology should be explored further.
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Affiliation(s)
- Matilda Wurm
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Caroline Lorenz
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | - Maria Tillfors
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Fredrik Holländare
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
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24
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Curtiss J, Klemanski DH, Andrews L, Ito M, Hofmann SG. The conditional process model of mindfulness and emotion regulation: An empirical test. J Affect Disord 2017; 212:93-100. [PMID: 28157552 PMCID: PMC5340204 DOI: 10.1016/j.jad.2017.01.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/21/2016] [Accepted: 01/22/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The conditional process model (CPM) of mindfulness and emotion regulation posits that specific mediators and moderators link these constructs to mental health outcomes. The current study empirically examined the central tenets of the CPM, which posit that nonreactivity moderates the indirect effect of observation on symptoms of emotional disorders through cognitive emotion regulation strategies. METHODS A clinical sample (n=1667) of individuals from Japan completed a battery of self-report instruments. Several path analyses were conducted to determine whether cognitive emotion regulation strategies mediate the relationship between observation and symptoms of individual emotional disorders, and to determine whether nonreactivity moderated these indirect effects. RESULTS Results provided support the CPM. Specifically, nonreactivity moderated the indirect effect of observation on symptoms through reappraisal, but it did not moderate the indirect effect of observation on symptoms through suppression. LIMITATIONS Causal interpretations are limited, and cultural considerations must be acknowledged given the Japanese sample CONCLUSIONS: These results underscore the potential importance of nonreactivity and emotion regulation as targets for interventions.
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Affiliation(s)
- Joshua Curtiss
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Leigh Andrews
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Masaya Ito
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
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25
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Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among psychiatric outpatients. J Affect Disord 2016; 201:112-5. [PMID: 27195516 DOI: 10.1016/j.jad.2016.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/06/2016] [Accepted: 05/09/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Overall Anxiety Severity and Impairment Scale (OASIS) is a brief, transdiagnostic measure used to assess anxiety severity and related interference. The OASIS has demonstrated strong psychometric properties in previous investigations, however, it has yet to be validated using a transdiagnostic clinician-rated measure. METHODS We evaluated the factor structure, convergent and discriminant validity, and illness severity cut-scores of the OASIS in a sample of outpatients (N=202). RESULTS A confirmatory factor analysis indicated an unidimensional structure provided the best fit. The OASIS demonstrated good convergent validity and internal consistency. Using the Clinical Global Impression-Severity Scale (CGI-S), ROC curves showed OASIS scores of 6, 10 and 12 to indicate moderate, marked and severe illness severity, respectively. CONCLUSIONS The OASIS is a unidimensional self-report measure with good convergent validity and data from the current study provide illness severity cut-scores.
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26
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Shinmei I, Kobayashi K, Oe Y, Takagishi Y, Kanie A, Ito M, Takebayashi Y, Murata M, Horikoshi M, Dobkin RD. Cognitive behavioral therapy for depression in Japanese Parkinson's disease patients: a pilot study. Neuropsychiatr Dis Treat 2016; 12:1319-31. [PMID: 27354802 PMCID: PMC4908947 DOI: 10.2147/ndt.s104777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study evaluated the feasibility of cognitive behavioral therapy (CBT) for Japanese Parkinson's disease (PD) patients with depression. To increase cultural acceptability, we developed the CBT program using manga, a type of Japanese comic novel. METHODS Participants included 19 non-demented PD patients who had depressive symptoms (GRID-Hamilton Rating Scale for Depression score ≥8). A CBT program comprising six sessions was individually administered. We evaluated the feasibility and safety of the CBT program in terms of the dropout rate and occurrence of adverse events. The primary outcome was depressive symptom reduction in the GRID-Hamilton Rating Scale for Depression upon completion of CBT. Secondary outcomes included changes in the self-report measures of depression (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale-Depression), anxiety (Hospital Anxiety and Depression Scale-Anxiety, State and Trait Anxiety Inventory, Overall Anxiety Severity and Impairment Scale), functional impairment, and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey). RESULTS Of the 19 participants (mean age =63.8 years, standard deviation [SD] =9.9 years; mean Hohen-Yahr score =1.7, SD =0.8), one patient (5%) withdrew. No severe adverse event was observed. The patients reported significant improvements in depression (Hedges' g =-1.02, 95% confidence interval =-1.62 to -0.39). The effects were maintained over a 3-month follow-up period. Most of the secondary outcome measurements showed a small-to-moderate but nonsignificant effect size from baseline to post-intervention. CONCLUSION This study provides preliminary evidence that CBT is feasible among Japanese PD patients with depression. Similar approaches may be effective for people with PD from other cultural backgrounds. The results warrant replication in a randomized controlled trial.
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Affiliation(s)
- Issei Shinmei
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Kei Kobayashi
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuki Oe
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuriko Takagishi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychology, Surugadai University, Saitama, Japan
| | - Ayako Kanie
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaya Ito
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Risk Analysis Research Center, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Miho Murata
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical school, NJ, USA
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27
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Ito M, Horikoshi M, Kato N, Oe Y, Fujisato H, Nakajima S, Kanie A, Miyamae M, Takebayashi Y, Horita R, Usuki M, Nakagawa A, Ono Y. Transdiagnostic and Transcultural: Pilot Study of Unified Protocol for Depressive and Anxiety Disorders in Japan. Behav Ther 2016; 47:416-30. [PMID: 27157034 DOI: 10.1016/j.beth.2016.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/18/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
Abstract
Unified protocol (UP) is a transdiagnostic cognitive behavior therapy for emotional disorders. It remains unknown whether UP is applicable for use in non-Western countries and for depressive disorders. We therefore examined its feasibility for a Japanese clinical population using this clinical trial design, which is multicentered, open-labeled, and single-armed (Clinical registry: UMIN000008322). The primary outcome was severity of anxiety symptoms, as assessed using Structured Interview Guide for the Hamilton Anxiety Rating Scale. Secondary outcomes were depressive symptoms, clinical global impression, functioning, quality of life, affectivity, emotion regulation, and adverse events. Of the 28 prospective participants, 17 were eligible and enrolled (depressive disorders=9, anxiety disorders=8). Severity of anxiety symptoms, which decreased significantly after the intervention, remained low for 3months (Hedges' g=1.29, 95% CI=0.56-2.06). Similar tendencies were observed for secondary outcome measures. No severe adverse event occurred. Two participants dropped out of the intervention. High treatment adherence and interrater reliability were confirmed. Results suggest the feasibility of UP in the Japanese context sufficient to warrant a larger clinical trial.
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Affiliation(s)
- Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira.
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira
| | | | | | - Ayako Kanie
- National Center of Neurology and Psychiatry, Tokyo
| | - Mitsuhiro Miyamae
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira
| | | | | | | | | | - Yutaka Ono
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira
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28
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Ito M, Okumura Y, Horikoshi M, Kato N, Oe Y, Miyamae M, Hirabayashi N, Kanie A, Nakagawa A, Ono Y. Japan Unified Protocol Clinical Trial for Depressive and Anxiety Disorders (JUNP study): study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:71. [PMID: 26987315 PMCID: PMC4797168 DOI: 10.1186/s12888-016-0779-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The unified protocol for the transdiagnostic treatment of emotional disorders is a promising treatment approach that could be applicable to a broad range of mental disorders, including depressive, anxiety, trauma-related, and obsessive-compulsive disorders. However, no randomized controlled trial has been conducted to verify the efficacy of the unified protocol on the heterogeneous clinical population with depressive and anxiety disorders. METHODS/DESIGN The trial was designed as a single-center, assessor-blinded, randomized, 20-week, parallel-group superiority study in order to compare the efficacy of the combination of unified protocol and treatment-as-usual versus waiting-list with treatment-as-usual for patients with depressive and/or anxiety disorders. The primary outcome was depression at 21 weeks, assessed by the 17-item version of the GRID-Hamilton Rating Scale for Depression. Estimated minimum sample size was 27 participants in each group. We will also examine the treatment mechanisms, treatment processes, and neuropsychological correlates. DISCUSSION The results of this study will clarify the efficacy of the unified protocol for depressive and anxiety disorders, and the treatment mechanism, process, and neurological correlates for the effectiveness of the unified protocol. If its efficacy can be confirmed, the unified protocol may be of high clinical value for Japan, a country in which cognitive behavioral treatment has not yet been widely adopted. TRIAL REGISTRATION ClinicalTrials.gov NCT02003261 (registered on December 2, 2013).
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Affiliation(s)
- Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan.
| | - Yasuyuki Okumura
- Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Mitsuhiro Miyamae
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | | | - Ayako Kanie
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsuo Nakagawa
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
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