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Siegel P, Peterson BS. Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure. J Child Psychol Psychiatry 2024. [PMID: 39128857 DOI: 10.1111/jcpp.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions. METHODS A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible. RESULTS Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's d = 0.51-0.95) and self-reported fear (d = 0.45-1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (d = 0.54-0.62) and concomitant physiological arousal (d = 0.55-0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (d = 1.2-1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (d = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (d = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear. CONCLUSIONS Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.
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Affiliation(s)
- Paul Siegel
- Department of Psychology, Purchase College, State University of New York, Purchase, NY, USA
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley S Peterson
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychiatry, Children's Hospital Los Angeles, Institute for the Developing Mind, Los Angeles, CA, USA
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2
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Mishkin AD, Prince EJ, Leimbach EJ, Mapara MY, Carroll CP. Psychiatric comorbidities in adults with sickle cell disease: A narrative review. Br J Haematol 2023; 203:747-759. [PMID: 37455514 DOI: 10.1111/bjh.18981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Although descriptions of quality of life and patient reports of mood in sickle cell disease (SCD) have become more common in the literature, less is known about psychiatric illness prevalence, presentation, and treatment, particularly for adults. We provide a narrative review of what is known about common and debilitating psychiatric conditions such as depression, anxiety, and cognitive impairment, specifically for adults with SCD. We discuss the limitations of the current evidence, make provisional recommendations, and identify opportunities for research and improved care.
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Affiliation(s)
- Adrienne D Mishkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Blood and Marrow Transplantation Program, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth J Leimbach
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Markus Y Mapara
- Blood and Marrow Transplantation Program, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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3
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Erhardt A, Gelbrich G, Klinger-König J, Streit F, Kleineidam L, Riedel-Heller SG, Schmidt B, Schmiedek F, Wagner M, Grabe HJ, Rietschel M, Berger K, Deckert J. Generalised anxiety and panic symptoms in the German National Cohort (NAKO). World J Biol Psychiatry 2023; 24:881-896. [PMID: 34842503 DOI: 10.1080/15622975.2021.2011409] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Anxiety disorders (AD) are common in the general population, leading to high emotional distress and disability. The German National Cohort (NAKO) is a population-based mega-cohort study, examining participants in 16 German regions. The present study includes data of the first 101,667 participants and investigates the frequency and severity of generalised anxiety symptoms and panic attacks (PA). METHODS The Generalised Anxiety Disorder Symptoms Scale (GAD-7) and the first part of the Patient Health Questionnaire Panic Disorder (PHQ-PD) were filled out by NAKO participants (93,002). We examined the correlation of GAD-7 and PHQ-PD with demographic variables, stress (PHQ-Stress), depression (PHQ-9) and childhood trauma (CTS). RESULTS The total proportion of prior lifetime diagnoses of AD in the NAKO cohort reached 7.8%. Panic attacks were reported by 6.0% and possible/probable current GAD symptoms in 5.2% of the examined participants. Higher anxiety severity was associated with female sex, lower education level, German as a foreign language and younger age as well as high perceived stress and depression. CONCLUSIONS Clinically relevant GAD symptoms as well as panic attacks are frequent in the NAKO and are associated with sociodemographic factors, and high anxiety symptoms are accompanied by pronounced stress and depression levels.
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Affiliation(s)
- Angelika Erhardt
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
- Max Planck Institute for Psychiatry, Munich, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Wuerzburg, Germany
- Clinical Trial Centre Wuerzburg, University Hospital Würzburg, Wuerzburg, Germany
| | | | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Luca Kleineidam
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Germany
| | - Florian Schmiedek
- Leibniz-Institute for Research and Information in Education, University of Frankfurt, Germany
- Institute of Psychology, Goethe University, Frankfurt am Main, Germany
- Centre for Mind, Brain and Behaviour, University of Marburg and Justus Liebig University Giessen, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, Greifswald, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Muenster, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Centre of Mental Health, Julius-Maximilians-University, Wuerzburg, Germany
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4
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Lee DY, Choi B, Kim C, Fridgeirsson E, Reps J, Kim M, Kim J, Jang JW, Rhee SY, Seo WW, Lee S, Son SJ, Park RW. Privacy-Preserving Federated Model Predicting Bipolar Transition in Patients With Depression: Prediction Model Development Study. J Med Internet Res 2023; 25:e46165. [PMID: 37471130 PMCID: PMC10401196 DOI: 10.2196/46165] [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: 02/01/2023] [Revised: 03/10/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mood disorder has emerged as a serious concern for public health; in particular, bipolar disorder has a less favorable prognosis than depression. Although prompt recognition of depression conversion to bipolar disorder is needed, early prediction is challenging due to overlapping symptoms. Recently, there have been attempts to develop a prediction model by using federated learning. Federated learning in medical fields is a method for training multi-institutional machine learning models without patient-level data sharing. OBJECTIVE This study aims to develop and validate a federated, differentially private multi-institutional bipolar transition prediction model. METHODS This retrospective study enrolled patients diagnosed with the first depressive episode at 5 tertiary hospitals in South Korea. We developed models for predicting bipolar transition by using data from 17,631 patients in 4 institutions. Further, we used data from 4541 patients for external validation from 1 institution. We created standardized pipelines to extract large-scale clinical features from the 4 institutions without any code modification. Moreover, we performed feature selection in a federated environment for computational efficiency and applied differential privacy to gradient updates. Finally, we compared the federated and the 4 local models developed with each hospital's data on internal and external validation data sets. RESULTS In the internal data set, 279 out of 17,631 patients showed bipolar disorder transition. In the external data set, 39 out of 4541 patients showed bipolar disorder transition. The average performance of the federated model in the internal test (area under the curve [AUC] 0.726) and external validation (AUC 0.719) data sets was higher than that of the other locally developed models (AUC 0.642-0.707 and AUC 0.642-0.699, respectively). In the federated model, classifications were driven by several predictors such as the Charlson index (low scores were associated with bipolar transition, which may be due to younger age), severe depression, anxiolytics, young age, and visiting months (the bipolar transition was associated with seasonality, especially during the spring and summer months). CONCLUSIONS We developed and validated a differentially private federated model by using distributed multi-institutional psychiatric data with standardized pipelines in a real-world environment. The federated model performed better than models using local data only.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Byungjin Choi
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Republic of Korea
| | - Egill Fridgeirsson
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jenna Reps
- Observational Health Data Analytics, Janssen Research and Development, Titusville, NJ, United States
| | - Myoungsuk Kim
- Data Solution Team, Evidnet Co, Ltd, Sungnam, Republic of Korea
| | - Jihyeong Kim
- Data Solution Team, Evidnet Co, Ltd, Sungnam, Republic of Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seunghoon Lee
- Department of Psychiatry, Myongji Hospital, Goyang, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Republic of Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Republic of Korea
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Peng RX. How online searches fuel health anxiety: Investigating the link between health-related searches, health anxiety, and future intention. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Mullarkey M, Dobias M, Sung J, Ahuvia I, Shumake J, Beevers C, Schleider J. Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial. JMIR Ment Health 2022; 9:e33473. [PMID: 35230962 PMCID: PMC9007232 DOI: 10.2196/33473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. OBJECTIVE Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. METHODS We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. RESULTS Of 522 randomized individuals, 500 (95.8%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=-0.06 (95% CI -0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95% CI -0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=-0.02 (95% CI -0.23 to 0.19; P=.83). CONCLUSIONS Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455.
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Affiliation(s)
- Michael Mullarkey
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Mallory Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Jenna Sung
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Isaac Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Jason Shumake
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Christopher Beevers
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Jessica Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Using 360-degree videos for virtual reality exposure in CBT for panic disorder with agoraphobia: a feasibility study. Behav Cogn Psychother 2021; 50:158-170. [PMID: 34789348 DOI: 10.1017/s1352465821000473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PDA). However, implementation of some of the procedures involved, particularly in vivo exposure, can be time consuming and taxing for routine health care services. CBT with exposure taking place in virtual reality (VR-CBT) is a more time-efficient option and has shown promising results in the treatment of PDA. However, VR-CBT requires expensive equipment and appropriate virtual environments, which historically has been costly and cumbersome to produce. Thus, access to VR-CBT has been sparse in regular care environments. AIMS The aim of this study was to investigate whether VR-CBT using filmed virtual environments produced with a low-cost 360-degree film camera can be a feasible and acceptable treatment for PDA when implemented in a primary care context. METHOD This was an open feasibility trial with a within-group design, with assessments conducted at pre-test, post-test, and 6-month follow-up. Participants (n = 12) received a 10-12 week treatment programme of VR-CBT and PDA-related symptoms were assessed by the primary outcome measure The Mobility Inventory for Agoraphobia (MIA) and the Panic-Disorder Severity Scale-Self Rated (PDSS-SR). RESULTS The results showed that treatment satisfaction was high and participants were significantly improved on PDA-related measures at post-treatment and at 6-month follow-up with large effect sizes (Cohen's d range = 1.46-2.82). All 12 participants completed the treatment. CONCLUSIONS These findings suggest that VR-CBT with 360-degree video virtual environments delivered to primary care patients with PDA is feasible, acceptable, and potentially efficacious.
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8
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Xie Z, Jiang W, Deng M, Wang W, Xie X, Feng X, Shi Y, Zhang X, Song D, Yuan Z, Wang Y. Alterations of oral microbiota in patients with panic disorder. Bioengineered 2021; 12:9103-9112. [PMID: 34666612 PMCID: PMC8806997 DOI: 10.1080/21655979.2021.1994738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The main characteristics of panic disorder (PD) include recurrent panic attacks and persistent worry, accompanied by other physical and cognitive symptoms. While recent studies have revealed that gut bacteria play an important role in anxiety and depression, little is known about the relationship between oral microbiota and PD. Therefore, the objective of this study was to explore a possible correlation between oral microbiota and PD. We conducted 16S rRNA sequencing to compare differences in the oral microbiota of patients with PD (n = 26) and healthy controls (n = 40). Patients with PD exhibited higher alpha diversity (abundance and evenness) in their oral microbiota than healthy controls, while analysis of beta diversity revealed that the two groups differed in microbial community composition. Moreover, the relative abundance of 61 genera differed between them. Overall, PD resulted in distinct oral microbial profiles that could be potential diagnostic markers and therapeutic targets.
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Affiliation(s)
- Zunli Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiqing Jiang
- Department of Neurology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Mingzhu Deng
- Department of Health and Medicine, Xuchang Vocational Technical College, Xuchang, China
| | - Wei Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xian Xie
- Department of Computer Science and Technology, Donghua University, Shanghai, China
| | - Xia Feng
- Department of Neurology, The Second Affilliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yinping Shi
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziyu Yuan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonggang Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Headache Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Khoury JMB, Watt MC, MacLean K. Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic. Int J Cogn Ther 2021; 14:515-536. [PMID: 34178209 PMCID: PMC8216097 DOI: 10.1007/s41811-021-00113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.
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Affiliation(s)
- Juliana M B Khoury
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
| | - Margo C Watt
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada.,Departments of Psychology/Neuroscience and Psychiatry, Dalhousie University, Halifax, Nova Scotia Canada
| | - Kim MacLean
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
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Vera M, Obén A, Juarbe D, Hernández N, Pérez-Pedrogo C. Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:91-103. [PMID: 35813157 DOI: 10.1016/j.jbct.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n=30), ABBT (n=30), or treatment as usual (TAU) (n=30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.
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Affiliation(s)
- Mildred Vera
- Center for Evaluation and Sociomedical Research, Department of Health Services Administration, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Adriana Obén
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Deborah Juarbe
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Norberto Hernández
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Coralee Pérez-Pedrogo
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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11
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Stech EP, Chen AZ, Sharrock MJ, Grierson AB, Upton EL, Mahoney AEJ, Grisham JR, Newby JM. Internet-delivered exposure therapy versus internet-delivered cognitive behavioral therapy for panic disorder: A pilot randomized controlled trial. J Anxiety Disord 2021; 79:102382. [PMID: 33774558 DOI: 10.1016/j.janxdis.2021.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/19/2022]
Abstract
AIM To compare the efficacy and acceptability of internet-delivered exposure therapy for panic disorder, to multi-component internet-delivered cognitive behavioral therapy (iCBT) that included controlled breathing, cognitive restructuring and exposure. METHODS Participants with panic disorder, with or without agoraphobia, were randomized to internet-delivered exposure therapy (n = 35) or iCBT (n = 34). Both programs were clinician guided, with six lessons delivered over eight weeks. Outcomes included panic disorder and agoraphobia symptom severity, as well as depression symptom severity, functional impairment and days out of role. RESULTS Participants in both conditions displayed a large reduction in panic disorder symptom severity (ds >1.30) from pre- to post-treatment. Participants in both conditions displayed medium to large reduction in agoraphobia and depression symptom severity, functional impairment and days out of role. Effects were maintained at three- and six-month follow-up. There was no significant difference between the interventions in clinical outcomes, adherence or treatment satisfaction. CONCLUSIONS Internet-delivered exposure therapy appeared to be as acceptable and efficacious as more established iCBT, despite including less strategies. However, a fully powered replication is now needed to compare the two approaches.
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Affiliation(s)
- Eileen P Stech
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia.
| | - Aileen Z Chen
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Maria J Sharrock
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Ashlee B Grierson
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Emily L Upton
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Alison E J Mahoney
- School of Psychiatry, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales Sydney, NSW 2052, Australia; Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW 2010, Australia; Black Dog Institute, University of New South Wales Sydney, NSW 2052, Australia
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12
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Chang HH, Wong KH, Hung CR. Health Beliefs and Social Support Related to Anxiety about Electronic Health Record Systems: A Patient Visit Survey (Preprint). JMIR Form Res 2021. [DOI: 10.2196/29075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Horenstein A, Heimberg RG. Anxiety disorders and healthcare utilization: A systematic review. Clin Psychol Rev 2020; 81:101894. [DOI: 10.1016/j.cpr.2020.101894] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022]
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Abstract
OBJECTIVE Panic disorder (PD) is associated with somatization and high medical utilization in primary care settings. Treatment of PD could reduce the frequency of panic attacks and visits to emergency departments, but the associated change in medical utilization is unknown. This study investigated the change in medical utilization before and after a PD diagnosis. METHOD This study identified 8722 patients with PD enrolled in the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2012. We used a case-crossover study design to compare medical utilizations with a 1-year time window before and after new PD diagnoses, including medical examinations, specialty visits, and medication used. A conditional logistic regression model was used to estimate changes in comorbidity before and after new PD diagnoses. RESULTS The utilization of examinations-including electrocardiography, radiography, and sonography-decreased within 1 year after PD diagnosis compared with 1 year before PD diagnosis. Outpatient and emergency department visits to nonpsychiatric departments decreased (risk ratio [RR] = 0.989 [95% confidence interval {CI} = 0.985-0.993] and RR = 0.924 [95% CI = 0.894-0.956], respectively), whereas outpatient visits to psychiatric departments increased (RR = 1.193, 95% CI = 1.171-1.215). PD diagnosis is associated with increased use of antidepressants (RR = 12.65) and benzodiazepines (RR = 11.63), an increased ratio of comorbid depressive disorder (RR = 3.06) and bipolar disorder (RR = 1.77), and a decreased ratio of nonpanic anxiety disorder (RR = 0.69). CONCLUSIONS New PD diagnoses are associated with decreased laboratory examination and nonpsychiatric service utilization, along with increased psychiatric service utilization. We suggest that PD should be detected earlier for mitigating potentially unnecessary use of nonpsychiatric examinations and services.
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Kaplan A, Mannarino AP, Nickell PV. Evaluating the Impact of Freespira on Panic Disorder Patients' Health Outcomes and Healthcare Costs within the Allegheny Health Network. Appl Psychophysiol Biofeedback 2020; 45:175-181. [PMID: 32342249 DOI: 10.1007/s10484-020-09465-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Panic disorder (PD) is a debilitating condition that drives medical spending at least twice as high as medically matched controls. Excessive utilization of healthcare resources comes from emergency department (ED), medications, diagnostic testing, and physician visits. Freespira is an FDA-cleared digital therapeutic that treats PD and panic attacks (PA) by correcting underlying abnormal respiratory physiology. Efficacy of Freespira has been established in prior studies. This paper reports on a quality improvement program that investigated whether treating PD patients with Freespira would reduce medical costs and improve outcomes over 12-months. Panic symptoms were assessed using the Panic Disorder Severity Scale (PDSS). Pre-and post-treatment insurance claims determined costs. At baseline, mean Clinician Global Impression (CGI-S) was 4.4 (moderately/markedly ill), mean PDSS was 14.4 and mean PA frequency/week was 2 (range 0-5). Immediately post-treatment (week 5) mean CGI-S, PDSS and weekly PA frequency declined to 2.8 (borderline/mildly ill, 4.9 (remission) and 0.2 (range 0-2) respectively, p < 0.001. 82% reported PDSS decrease of ≥ 40% (clinically significant), 86% were PA-free. One-year post treatment mean CGI-S, PDSS and PA remained low at 2.1, 4.4, and 0.3 (range 0-1) respectively. 91% had PDSS decrease of ≥ 40%, 73% were PA-free. The majority of patients were panic attack free and/or reduced their symptoms and avoidance behaviors 1-year post Freespira treatment. Mean overall medical costs were reduced by 35% from $548 to $358 PMPM (per member per month) or an annual reduction of $2280. at 12 months post-treatment. There was a 65% reduction in ED costs from $87 to $30 PMPM. Median pharmacy costs were reduced by 68% from $73 to $23 PMPM.
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Affiliation(s)
- Alicia Kaplan
- Department of Psychiatry, Allegheny Health Network, 4 Allegheny Center 8th Floor, Pittsburgh, PA, 15212, USA.
| | - Anthony P Mannarino
- Department of Psychiatry, Allegheny Health Network, 4 Allegheny Center 8th Floor, Pittsburgh, PA, 15212, USA
| | - P V Nickell
- Department of Psychiatry, Allegheny Health Network, 4 Allegheny Center 8th Floor, Pittsburgh, PA, 15212, USA
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Rahmat R. Urinary frequency: going beyond the tract. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:58-60. [PMID: 32284808 PMCID: PMC7136674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a common anxiety disorder which can be chronic and sustained. An OCD sufferer experiences intrusive and repetitive thoughts, impulses, and behaviors, which ultimately cause extreme discomfort. We report a case of a patient that primarily presented with lower urinary tract symptoms who was subsequently treated with antibiotics. Nonetheless, the symptoms persisted. In subsequent consultations, the patient clarified the compulsive nature of his symptoms and was treated as a case of OCD. Therefore, it is crucial for physicians to correctly identify the nature of the symptoms to manage the disorder properly and to avoid unnecessary consultation and treatment. To the best of our knowledge, this is the first report of other presentations of OCD.
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Affiliation(s)
- R Rahmat
- MD (UKM), MMED Family Medicine (USM) Klinik Kesihatan Taiping, Perak Malaysia
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17
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Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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18
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Sex differences in incidence and psychiatric comorbidity for alcohol dependence in patients with panic disorder. Drug Alcohol Depend 2020; 207:107814. [PMID: 31887603 DOI: 10.1016/j.drugalcdep.2019.107814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/13/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sex differences in the development of alcohol dependence (AD) among patients with panic disorder (PD) remain unexplored. The study investigated sex as an effect modifier in the incidence of AD among patients with PD. METHOD We included 9480 patients with PD from the Taiwan National Health Insurance Research Database. A total of 169 patients (89 men and 80 women) developed incident AD during the follow-up period. Standardized incidence ratios (SIRs) were used to represent the relative risks of incident AD compared with the general population. Based on a nested case-control study design, 10 controls were selected for each case. Medical utilization and psychiatric comorbidity before diagnosing AD were analyzed using conditional logistic regression. RESULTS The SIR of incident AD was 3.36 for men and 6.29 for women. Women with PD and incident AD had more visits to the outpatient department than the controls did, whereas men exhibited no significant differences. Women with incident AD were more likely to comorbid with depressive disorder (adjusted risk ratio [aRR] = 2.94), personality disorder (aRR = 5.03), and sleep disorder (aRR = 1.72), whereas men with incident AD were more likely to comorbid with sleep disorder (aRR = 1.85) and other substance use disorders (aRR = 3.08). CONCLUSION Patients with PD have an additional risk of developing AD compared with the general population, and that risk is higher in women. Women and men exhibited dissimilar patterns of medical utilization and psychiatric comorbidity before developing AD. Sex differences should be taken into consideration when establishing preventive measures.
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Chang HM, Pan CH, Chen PH, Chen YL, Su SS, Tsai SY, Chen CC, Kuo CJ. Identification and medical utilization of newly diagnosed panic disorder: A Nationwide case-control study. J Psychosom Res 2019; 125:109815. [PMID: 31450125 DOI: 10.1016/j.jpsychores.2019.109815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Ascertaining comorbid illnesses and patterns of medical utilization early in the course of psychiatric illness can help identify patients with panic disorder. We investigated how such cases were diagnosed and the comorbidities associated with newly diagnosed panic disorder in a nationwide database. METHODS We enrolled a large representative cohort of the general population in Taiwan (N = 1000,000) and selected 9759 cases of panic disorder from January 1, 2000 to December 31, 2013. The distribution of the departments in which the cases were identified and the medical utilization 12 months before diagnosis were analyzed. Based on a nested case-control study, four controls were randomly selected for each case and matched for sex, age, and incidence year. Conditional logistic regression was used to explore the factors associated with newly-diagnosed panic disorder such as demographic factors, concomitant medications, and physical and psychiatric comorbidities. RESULTS Most (58.5%) cases of panic disorder were diagnosed in the psychiatry department, whereas only 3.7% were identified in the emergency department. Before diagnosis, the patients frequently visited the departments of internal medicine, family practice, and Chinese herbal medicine. A multivariate analysis revealed a higher number of physical and psychiatric comorbidities before diagnosis in the cases compared with the controls, especially depressive disorder and other anxiety disorders. CONCLUSIONS Individuals with certain comorbidities and patterns of medical utilization are more likely to be diagnosed with panic disorder. We suggest providing more training to general practitioners and emergency physicians for the early diagnosis of panic disorder.
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Affiliation(s)
- Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Shiang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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20
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Davis TE, Ollendick TH, Öst LG. One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review. Annu Rev Clin Psychol 2019; 15:233-256. [PMID: 30550722 DOI: 10.1146/annurev-clinpsy-050718-095608] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803, USA;
| | - Thomas H Ollendick
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24060, USA;
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden;
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21
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Oser M, Wallace ML, Solano F, Szigethy EM. Guided Digital Cognitive Behavioral Program for Anxiety in Primary Care: Propensity-Matched Controlled Trial. JMIR Ment Health 2019; 6:e11981. [PMID: 30946022 PMCID: PMC6470461 DOI: 10.2196/11981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is the gold standard treatment for adult anxiety disorders but is often not readily available in a scalable manner in many clinical settings. OBJECTIVE This study examines the feasibility, acceptability, and effectiveness of a coach-facilitated digital cognitive behavioral program for anxious adults in primary care. METHODS In an open trial, patients who screened positive for anxiety (General Anxiety Disorder-7 [GAD7] score ≥5) were offered the digital cognitive behavioral program (active group, n=593). Primary outcomes included anxiety, quality of life (QoL), and ambulatory medical use over 6 months. Intent-to-treat (ITT) and modified intent-to-treat (mITT) analyses were completed. Subsequently, we compared the outcomes of participants with those of a matched control group receiving primary care as usual (CAU; n=316). RESULTS More than half of the patients downloaded the cognitive behavioral mobile app program and about 60% of these were considered engaged, which was defined as completion of ≥3 techniques. The active group demonstrated medium size effects on reducing anxiety symptoms (effect size d=0.44; P<.001) and improving mental health QoL (d=0.49; P<.001) and showed significantly improved physical health QoL (d=0.39; P=.002) and a decreased likelihood of high utilization of outpatient medical care (odds ratio=0.49; P<.001). The active group did not significantly outperform the CAU group in anxiety reduction or QoL improvement (d=0.20; P=.07). However, intent-to-treat analysis showed that the active group had a significantly lower likelihood of high utilization of outpatient medical care than the enhanced CAU group (P<.0001; odds ratio=0.09). CONCLUSIONS A coach-facilitated digital cognitive behavioral program prescribed in primary care is feasible and acceptable. Primary care patients prescribed a digital cognitive behavioral program for anxiety experienced significant improvements in anxiety symptoms, QoL, and reduced medical utilization. This effect was observed even among patients with chronic medical conditions and behavioral health comorbidities. Although the primary outcomes in the active group did not improve significantly more than the CAU group, health care utilization declined, and some secondary outcomes improved in participants who engaged in the program compared to the CAU group. TRIAL REGISTRATION ClinicalTrials.gov NCT03186872; https://clinicaltrials.gov/ct2/show/NCT03186872.
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Affiliation(s)
- Megan Oser
- Lantern, San Francisco, CA, United States
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Francis Solano
- Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Eva Maria Szigethy
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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22
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Hohls JK, Wild B, Heider D, Brenner H, Böhlen F, Saum KU, Schöttker B, Matschinger H, Haefeli WE, König HH, Hajek A. Association of generalized anxiety symptoms and panic with health care costs in older age-Results from the ESTHER cohort study. J Affect Disord 2019; 245:978-986. [PMID: 30562680 DOI: 10.1016/j.jad.2018.11.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known specifically about the association between generalized anxiety symptoms or panic and health care costs in older age. The aim of this study was to examine the association between generalized anxiety symptoms, panic and health care costs in people aged 65 and over. METHODS Cross-sectional data from the 8-year follow-up of a large, prospective cohort study, the ESTHER study, was used. Individuals aged 65 and over, who participated in the study's home assessment, were included in this analysis (n = 2348). Total and sectoral costs were analyzed as a function of either anxiety symptoms, probable panic disorder, or a panic attack, while controlling for selected covariates, using Two Part and Generalized Linear Models. Covariates were chosen based on Andersen's Behavioral Model of Health Care Use. RESULTS There was no significant association between either of the anxiety or panic measures and total health care costs. Stratified by health care sectors, only the occurrence of a panic attack was significantly associated with incurring costs for outpatient non-physician services (OR: 1.99; 95% CI: 1.15-3.45) and inpatient services (OR: 2.14; 95% CI: 1.07-4.28). Other illness-related factors, such as comorbidities and depressive symptoms, were associated with health care costs in several models. LIMITATIONS This was a cross-sectional study relying on self-reported data. CONCLUSION This study points to an association between a panic attack and sector-specific health care costs in people aged 65 and over. Further research, especially using longitudinal data, is needed.
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Affiliation(s)
- J K Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
| | - B Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - D Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - F Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - W E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Bushnell GA, Gaynes BN, Compton SN, Dusetzina SB, Brookhart MA, Stürmer T. Incidence of mental health hospitalizations, treated self-harm, and emergency room visits following new anxiety disorder diagnoses in privately insured U.S. children. Depress Anxiety 2019; 36:179-189. [PMID: 30358025 PMCID: PMC6488302 DOI: 10.1002/da.22849] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/06/2018] [Accepted: 09/22/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Anxiety disorders are one of the most common mental illnesses in children and associated with high healthcare utilization. We aimed to estimate 2-year cumulative incidence of mental health-related hospitalizations, treated self-harm, and emergency room (ER) visits in children newly diagnosed with anxiety disorders and, for context, in children without anxiety disorders. METHODS We identified commercially insured treatment naïve children (3-17 years) with a new office-based anxiety disorder diagnosis (ICD-9-CM) from 2005-2014 in the MarketScan claims database. We followed children for up to 2 years after diagnosis for the first of each event: mental health-related hospitalization, inpatient, treated self-harm, and ER visits (any, anxiety-related, injury-related). Children without anxiety diagnoses were included as comparators, matched on age, sex, date, and region. We estimated cumulative incidence of each event using Kaplan-Meier analysis. RESULTS From 2005-2014, we identified 198,450 children with a new anxiety diagnosis. One-year after anxiety diagnosis, 2.0% of children had a mental health-related hospitalization, 0.08% inpatient, treated self-harm, 1.4% anxiety-related ER visit, and 20% any ER visit; incidence was highest in older children with baseline comorbid depression. One-year cumulative incidence of each event was lower in the comparison cohort without anxiety (e.g., mental health-related hospitalizations = 0.5%, treated self-harm = 0.01%, and ER visits = 13%). CONCLUSIONS Given the prevalence of anxiety disorders, 2-year incidence estimates translate to a significant number of children experiencing each event. Our findings offer caregivers, providers, and patients information to better understand the burden of anxiety disorders and can help anticipate healthcare utilization and inform efforts to prevent these serious events.
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Affiliation(s)
- Greta A Bushnell
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA,Current affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stacie B Dusetzina
- Department of Health Policy and Management, Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy and the University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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Wolitzky-Taylor K, Chung B, Bearman SK, Arch J, Grossman J, Fenwick K, Lengnick-Hall R, Miranda J. Stakeholder Perceptions of the Barriers to Receiving and Delivering Exposure-Based Cognitive Behavioral Therapy for Anxiety Disorders in Adult Community Mental Health Settings. Community Ment Health J 2019; 55:83-99. [PMID: 29508179 PMCID: PMC6123294 DOI: 10.1007/s10597-018-0250-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administrator) to assess patient and provider/administrator perceptions of the barriers to delivering (or receiving) CBT for anxiety disorders. Providers/administrators from two counties in California (N = 106) indicated lack of training/competency as primary barriers. Patients in one large county (N = 42) reported their own symptoms most often impacted treatment receipt. Both groups endorsed acceptability of exposure but indicated that its use in treatment provided/received had been limited. Implications and recommendations are discussed.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA.
- Department of Social Work, University of Southern California, Los Angeles, CA, USA.
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA.
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA.
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Sarah Kate Bearman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Joanna Arch
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Jason Grossman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Karissa Fenwick
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Rebecca Lengnick-Hall
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Social Work, University of Southern California, Los Angeles, CA, USA
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
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Sanchez Gonzalez ML, McCord CE, Dopp AR, Tarlow KR, Dickey NJ, McMaughan DK, Elliott TR. Telemental health training and delivery in primary care: A case report of interdisciplinary treatment. J Clin Psychol 2018; 75:260-270. [PMID: 30589440 DOI: 10.1002/jclp.22719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth-specific practice implications, especially as they pertain to training settings.
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Affiliation(s)
| | - Carly E McCord
- Department of Psychiatry and Department of Educational Psychology, Texas A&M University, Texas
| | - Alex R Dopp
- Department of Psychological Sciences, University of Arkansas, Arkansas
| | | | - Nancy J Dickey
- Department of Family & Community Medicine, Texas A&M University, Texas
| | - Darcy K McMaughan
- Health Policy and Management Department, Texas A&M University, Texas
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2018. [DOI: 10.1177/0004867418799453] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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Remes O, Wainwright N, Surtees P, Lafortune L, Khaw KT, Brayne C. Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study. BMJ Open 2018; 8:e018539. [PMID: 30368445 PMCID: PMC6224748 DOI: 10.1136/bmjopen-2017-018539] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Generalised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions. DESIGN Large, population study. SETTING UK population-based cohort. PARTICIPANTS 30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996-2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates. MAIN OUTCOME MEASURE Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS In this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49). CONCLUSION People with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.
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Affiliation(s)
- Olivia Remes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nicholas Wainwright
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Surtees
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Wright BD, Cooper C, Scott AJ, Tindall L, Ali S, Bee P, Biggs K, Breckman T, Davis Iii TE, Gega L, Hargate RJ, Lee E, Lovell K, Marshall D, McMillan D, Teare MD, Wilson J. Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive-behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial. BMJ Open 2018; 8:e025031. [PMID: 30121618 PMCID: PMC6104754 DOI: 10.1136/bmjopen-2018-025031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Specific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive-behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like one-session treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are 'no worse' than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society. METHOD A pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children's, parents' and practitioners' perceptions and experiences of OST. A total of 286 children, 7-16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts. ETHICS AND DISSEMINATION The trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers. TRIAL REGISTRATION NUMBER ISRCTN19883421;Pre-results.
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Affiliation(s)
- Barry D Wright
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Cindy Cooper
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Lucy Tindall
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Shehzad Ali
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Katie Biggs
- ScHARR, The University of Sheffield, Sheffield, UK
| | | | - Thompson E Davis Iii
- Psychological Services Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Lina Gega
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Rebecca Julie Hargate
- Child Oriented Mental Health Intervention Centre, IT Centre, Innovation Way, York, UK
| | - Ellen Lee
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - M Dawn Teare
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Jonathan Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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Screening for panic-related anxiety in emergency department patients with cardiopulmonary complaints: A comparison of two self-report instruments. Psychiatry Res 2018; 263:7-14. [PMID: 29482044 DOI: 10.1016/j.psychres.2018.02.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 12/13/2022]
Abstract
The present study examined 1) the accuracy of two self-report measures for detecting panic-related anxiety in emergency department (ED) patients with cardiopulmonary complaints; and 2) whether modified scoring resulted in improved performance. English-speaking adults presenting to the ED of a large public hospital with palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety with the Structured Clinical Interview for DSM-IV (SCID) over a one-year period. Patients completed the panic disorder modules of the Patient Health Questionnaire (PHQ-PD) and Psychiatric Diagnostic Screening Questionnaire (PDSQ-PD). Sensitivity, specificity, area under the curve (AUC), and predictive values were compared for various cut-offs and scoring algorithms using SCID diagnosis of panic attacks (in the absence of panic disorder) or panic disorder as the reference standard. In this sample of 200 participants, the majority had a chief complaint of chest pain and 46.5% met SCID criteria for panic-related anxiety. The PDSQ-PD demonstrated only fair operating characteristics for panic attacks (AUC = 0.57) and good operating characteristics for panic disorder (AUC = 0.79). The PHQ-PD achieved adequate operating characteristics (AUC = 0.66) for panic attacks and good operating characteristics for panic disorder (AUC = 0.76) using a modified scoring algorithm or a single screening question (AUC = 0.72).
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A Brief Interview to Detect Panic Attacks and Panic Disorder in Emergency Department Patients with Cardiopulmonary Complaints. J Psychiatr Pract 2018; 24:32-44. [PMID: 29320381 DOI: 10.1097/pra.0000000000000283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting. MATERIALS AND METHODS English-speaking adult ED patients with a chief complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic attacks and panic disorder with the Structured Clinical Interview for DSM-IV Axis I Disorders. Participants completed self-report measures to assess panic-related symptoms, comorbid psychiatric conditions, health-related disability, and health service use. RESULTS In this sample (N=200), 23.5% had panic attacks and 23.0% had panic disorder. Both groups reported higher rates of panic attack symptoms, greater psychiatric comorbidity, greater health-related disability, and higher rates of ED and mental health service use compared with those without either condition. A brief 7-item tool consisting of panic symptoms identified patients with panic attacks or panic disorder with 85% accuracy (area under the curve=0.90, sensitivity=82%, specificity=88%). CONCLUSIONS Patients with panic attacks or panic disorder commonly present to the ED, but often go unrecognized. A brief 7-item clinician rating scale accurately identifies these patients among those ED patients presenting with cardiopulmonary complaints.
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Greenslade JH, Hawkins T, Parsonage W, Cullen L. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms. Heart Lung Circ 2017; 26:1310-1316. [DOI: 10.1016/j.hlc.2017.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/09/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Fergus TA, Griggs JO, Cunningham SC, Kelley LP. Health anxiety and medical utilization: The moderating effect of age among patients in primary care. J Anxiety Disord 2017; 51:79-85. [PMID: 28689676 DOI: 10.1016/j.janxdis.2017.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/05/2017] [Accepted: 06/11/2017] [Indexed: 11/27/2022]
Abstract
Health anxiety is commonly seen in medical clinics and is related to the overutilization of primary care services, but existing studies have not yet considered the possible moderating effect of age. We examined if age moderated the association between health anxiety and medical utilization. A secondary aim was to examine potential racial/ethnic differences in health anxiety. An ethnoracially diverse group of patients (N=533) seeking treatment from a primary care clinic completed a self-report measure of health anxiety. Three indices of medical utilization were assessed using medical records, including the number of: (a) clinic visits over the past two years, (b) current medications, and (c) lab tests over the past two years. Age moderated the effect of health anxiety on multiple indices of medical utilization. Supplemental analyses found that the moderating effect of age was specific to a somatic/body preoccupation, rather than health worry, dimension of health anxiety. Mean-level differences in health anxiety were either not supported (health anxiety composite, somatic/body preoccupation) or were small in magnitude (health worry) among self-identifying Black, Latino, and White participants. Results indicate that assessing for health anxiety could be particularly important for older adult patients who frequently seek out medical services.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, 76798 TX, USA.
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | | | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Kujanpää TS, Jokelainen J, Auvinen JP, Timonen MJ. The association of generalized anxiety disorder and Somatic Symptoms with frequent attendance to health care services: A cross-sectional study from the Northern Finland Birth Cohort 1966. Int J Psychiatry Med 2017; 52:147-159. [PMID: 28792287 DOI: 10.1177/0091217417720894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Generalized anxiety disorder is associated with higher rate of physical comorbities, unexplained symptoms, and health care utilization. However, the role of somatic symptoms in determining health care utilization is unclear. The present study aims to assess the association of frequent attendance of health care services between generalized anxiety disorder symptoms and somatic symptoms. Method This study was conducted cross-sectionally using the material of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Altogether, 5585 cohort members responded to the questionnaires concerning health care utilization, illness history, physical symptoms, and generalized anxiety disorder-7 screening tool. Odds ratios belonging to the highest decile in health care utilization were calculated for generalized anxiety disorder symptoms and all (n = 4) somatic symptoms of Hopkins Symptom Checklist-25 controlled for confounding factors. Results Adjusted Odds ratios for being frequent attender of health care services were 2.29 (95% CI 1.58-3.31) for generalized anxiety disorder symptoms and 1.28 (95% CI 0.99-1.64), 1.94 (95% CI 1.46-2.58), 2.33 (95% CI 1.65-3.28), and 3.64 (95% CI 2.15-6.18) for 1, 2, 3, and 4 somatic symptoms, respectively. People with generalized anxiety disorder symptoms had on average a higher number of somatic symptoms (1.8) than other cohort members (0.9). Moreover, 1.6% of people without somatic symptoms tested positive for generalized anxiety disorder, meanwhile 22.6% of people with four somatic symptoms tested positive for generalized anxiety disorder. Conclusions Both generalized anxiety disorder symptoms and somatic symptoms are associated with a higher risk for being a health care frequent attender.
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Affiliation(s)
- Tero S Kujanpää
- 1 Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- 1 Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,2 Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Juha P Auvinen
- 1 Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,2 Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - Markku J Timonen
- 1 Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,2 Unit of Primary Care, Oulu University Hospital, Oulu, Finland
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Cailhol L, Francois M, Thalamas C, Garrido C, Birmes P, Pourcel L, Lapeyre-Mestre M, Paris J. Is borderline personality disorder only a mental health problem? Personal Ment Health 2016; 10:328-336. [PMID: 27735136 DOI: 10.1002/pmh.1350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/28/2016] [Accepted: 08/24/2016] [Indexed: 11/07/2022]
Abstract
Patients with borderline personality disorder (BPD) have been shown to have increased rates of the use of medical services. The objective of this multicentre study was to compare the utilization of physical health services by patients with severe BPD (n = 36) with that of two control groups: one with other personality disorders (PDs) (n = 38) and one with matched subjects randomly selected from the general population (n = 165). Information was drawn from an insurance database collected over a 5-year period. The results showed that the BPD group had a higher mean number of medication prescriptions (377.3 vs. 97.4, p < 0.001), general medical consultations (34.4 vs. 13.2, p < 0.05) and days of medical or surgical hospitalization (10.2 vs. 1.9, p = 0.03). However, there were no significant differences between the groups with BPD and other PDs. The annual health-care cost for each BPD patient is estimated to be 12 761 euros, of which 17.6% is due to somatic care. In the BPD group, co-morbidity for narcissistic PD (NPD) contributed to the overall use of medications and hospitalization use. Combined with other data, this exploratory study shows that BPD is a medical burden and not just a psychiatric one. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lionel Cailhol
- Psychiatrie, Saint Jérôme, Saint-Jérôme, Quebec, Canada.
| | | | | | | | | | | | | | - Joel Paris
- Psychiatry, Institute of Community and Family Psychiatry, Montreal, Quebec, Canada
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Kujanpää T, Jokelainen J, Auvinen J, Timonen M. Generalised anxiety disorder symptoms and utilisation of health care services. A cross-sectional study from the "Northern Finland 1966 Birth Cohort". Scand J Prim Health Care 2016; 34:151-8. [PMID: 27054674 PMCID: PMC4977937 DOI: 10.3109/02813432.2016.1160631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyse the utilization of health care services of people who tested positive for GAD compared to those who tested negative. SETTING A cross-sectional study from the Northern Finland 1966 Birth Cohort. SUBJECTS A total of 10,282 members followed from birth in a longitudinal study were asked to participate in a follow-up survey at the age of 46. As part of this survey they filled in questionnaries concerning health care utilization and their illness history as well as the GAD-7 screening tool. Althogether 5,480 cohort members responded to the questionnaries. MAIN OUTCOME MEASURES Number of visits in different health care services among people who tested positive for GAD with the GAD-7 screening tool compared to those who tested negative. RESULTS People who tested positive for GAD had 112% more total health care visits, 74% more total physician visits, 115% more visits to health centres, 133% more health centre physician visits, 160% more visits to secondary care, and 775% more mental health care visits than those who tested negative. CONCLUSION People with GAD symptoms utilize health care services more than other people. Key Points Generalised anxiety disorder (GAD) is a common but poorly identified mental health problem in primary care. People who tested positive for GAD utilise more health care services than those who tested negative. About 58% of people who tested positive for GAD had visited their primary care physician during the past year. Only 29% of people who tested positive for GAD had used mental health services during the past year.
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Affiliation(s)
- Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- CONTACT Tero Kujanpää Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
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37
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Olariu E, Forero CG, Castro-Rodriguez JI, Rodrigo-Calvo MT, Álvarez P, Martín-López LM, Sánchez-Toto A, Adroher ND, Blasco-Cubedo MJ, Vilagut G, Fullana MA, Alonso J. DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES. Depress Anxiety 2015; 32:471-84. [PMID: 25826526 DOI: 10.1002/da.22360] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/27/2015] [Accepted: 01/31/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders. METHODS Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses. RESULTS Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998). CONCLUSIONS The use of diagnostic tools might improve detection of anxiety disorders in "primary care."
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Affiliation(s)
- Elena Olariu
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carlos G Forero
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jose Ignacio Castro-Rodriguez
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | | | - Pilar Álvarez
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Luis M Martín-López
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Alicia Sánchez-Toto
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Núria D Adroher
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Maria J Blasco-Cubedo
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gemma Vilagut
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miquel A Fullana
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain
| | - Jordi Alonso
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
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Schwarz J, Prashad A, Winchester DE. Prevalence and implications of severe anxiety in a prospective cohort of acute chest pain patients. Crit Pathw Cardiol 2015; 14:44-7. [PMID: 25679088 PMCID: PMC4331450 DOI: 10.1097/hpc.0000000000000038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Anxiety is a common condition which can manifest with symptoms of chest discomfort. Chest discomfort is one of the most common reasons to seek emergency medical care. We hypothesize that anxiety is highly prevalent, poorly diagnosed, and poorly treated in an acute care environment. We analyzed data from a prospective registry of chest pain patients with low to intermediate likelihood of acute coronary syndrome and coronary artery disease. Scores from the General Anxiety Disorder-7 questionnaire determined the prevalence of anxiety. Differences in presentation, evaluation, and 30-day outcomes were compared for subjects with and without severe anxiety. Of the 151 included subjects, severe anxiety was observed in 15%, moderate 14%, mild 30%, and 41% had no anxiety symptoms. Subjects with severe anxiety had similar baseline characteristics, cardiac risk factors, and symptoms to those without severe anxiety, except for the current use of tobacco (50.0% vs. 18.6%; P = 0.001). Anxiety was self-reported by 54.5% of subjects with severe anxiety and 27.3% were on antianxiety medications. Hospital admission (P = 0.888) and repeated emergency department visits within 30 days (P = 0.554) were not different between the 2 groups. Anxiety is common among patients seeking emergency evaluation of chest pain. Half of patients with severe anxiety were diagnosed and roughly one quarter were medically treated. Cardiac risk factors and symptoms are not different for patients with severe anxiety; these patients warrant a similar evaluation for heart disease as those patients without anxiety.
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Affiliation(s)
- Julio Schwarz
- From the * Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL; and † University of Florida, Gainesville, FL
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Predictors of healthcare service utilization for mental health reasons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10559-86. [PMID: 25321874 PMCID: PMC4210995 DOI: 10.3390/ijerph111010559] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 01/04/2023]
Abstract
This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.
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Blakeley C, Blakemore A, Hunter C, Guthrie E, Tomenson B, Dickens C. Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis. J Psychosom Res 2014; 77:232-9. [PMID: 25149033 PMCID: PMC4153376 DOI: 10.1016/j.jpsychores.2014.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma. METHODS Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models. RESULTS 8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR=1.078, p=0.476), regardless of the type of service, or type of medical condition. CONCLUSIONS Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care.
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Affiliation(s)
- Claire Blakeley
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK.
| | - Amy Blakemore
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK; NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Sciences Centre, University of Manchester, Williamson Building, Oxford Road, M13 9WL, UK
| | - Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford OX3 7LF, UK
| | - Else Guthrie
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Chris Dickens
- Mental Health Research Group, University of Exeter Medical School, UK; National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK
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Kao LT, Xirasagar S, Chung KH, Lin HC, Liu SP, Chung SD. Weekly and holiday-related patterns of panic attacks in panic disorder: a population-based study. PLoS One 2014; 9:e100913. [PMID: 25006664 PMCID: PMC4090070 DOI: 10.1371/journal.pone.0100913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While chronobiological studies have reported seasonal variation in panic attacks (PA) episodes, information on the timing of PA by week-days may enable better understanding of the triggers of PA episodes and thereby provide pointers for suitable interventional approaches to minimize PA attacks. This study investigated weekly variation in potential PA admissions including associations with holidays using a population-based longitudinal, administrative claims-based dataset in an Asian population. METHODS This study used ambulatory care data from the "Longitudinal Health Insurance Database 2000. We identified 993 patients with panic disorder (PD), and they had 4228 emergency room (ER) admissions for potential PA in a 3-year period between 1 January 2009 and 31 December 2011. One-way analysis of variance (ANOVA) was used to examine associations between the potential PA admissions and holidays/weekend days/work-days of the week. RESULTS The daily mean number of potential PA admissions was 3.96 (standard deviation 2.05). One-way ANOVA showed significant differences in potential PA admissions by holiday and day of the week (p<0.001). Daily frequencies showed a trough on Wednesday-Thursday, followed by a sharp increase on Saturday and a peak on Sunday. Potential PA admissions were higher than the daily mean for the sample patients by 29.4% and 22.1%, respectively on Sundays and holidays. Furthermore, the weekly variations were similar for females and males, although females always had higher potential PA admissions on both weekdays and holidays than the males. CONCLUSIONS We found that potential PA admissions among persons with PD varied systematically by day of the week, with a significant peak on weekends and holidays.
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Affiliation(s)
- Li-Ting Kao
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sudha Xirasagar
- Arnold School of Public Health, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kuo-Hsuan Chung
- Taipei Medical University Hospital, Department of Psychiatry, Taipei, Taiwan
- Taipei Medical University, School of Medicine, Department of Psychiatry, Taipei, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Medical University, School of Health Care Administration, Taipei, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Shiu-Dong Chung
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- * E-mail:
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Fetzner MG, Asmundson GJG, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ, Carleton RN. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther 2014; 43:262-74. [PMID: 24961385 DOI: 10.1080/16506073.2014.929170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol 2014; 28:403-39. [PMID: 24713617 DOI: 10.1177/0269881114525674] [Citation(s) in RCA: 377] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
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Affiliation(s)
- David S Baldwin
- 1Faculty of Medicine, University of Southampton, Southampton, UK
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Zerr AA, Pina AA. Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services. CHILD & YOUTH CARE FORUM 2014; 43:151-164. [PMID: 24683301 PMCID: PMC3964616 DOI: 10.1007/s10566-013-9230-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral (MEB) disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety. OBJECTIVE Informed by the Behavioral Model of Health Services Use (BMHS), the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity). METHOD Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families. RESULTS Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment. CONCLUSION Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.
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Shirneshan E, Bailey J, Relyea G, Franklin BE, Solomon DK, Brown LM. Incremental direct medical expenditures associated with anxiety disorders for the U.S. adult population: evidence from the Medical Expenditure Panel Survey. J Anxiety Disord 2013; 27:720-7. [PMID: 24135257 DOI: 10.1016/j.janxdis.2013.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 11/17/2022]
Abstract
Data from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS) were used to estimate the annual incremental healthcare expenditures associated with anxiety disorders, for the ambulatory adult population of the U.S. Individuals 18 years and older, who reported a diagnosis of, or had a medical event associated with anxiety disorder(s), were classified as anxiety population. Multivariate regression analyses, using generalized linear models, were conducted to calculate incremental costs associated with anxiety disorders. 8.74% of adult respondents reported being diagnosed with anxiety disorder(s). The annual overall healthcare expenditure associated with anxiety disorders was estimated at $1657.52 per person (SE: $238.83; p<0.001). Inpatient visits, prescription medications, and office-based visits together accounted for almost 93% of the overall cost. Given the prevalence of self-reported anxiety disorders in MEPS, their total direct medical expenditure is estimated at approximately $33.71 billion in 2013 US dollars, meaning this category of mental illnesses absorbs a significant portion of the U.S. healthcare resources.
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Affiliation(s)
- Elaheh Shirneshan
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, United States.
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Carroll PC, Haywood C, Hoot MR, Lanzkron S. A preliminary study of psychiatric, familial, and medical characteristics of high-utilizing sickle cell disease patients. Clin J Pain 2013; 29:317-23. [PMID: 23246997 DOI: 10.1097/ajp.0b013e3182579b87] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify demographic, medical, and psychosocial characteristics that distinguished sickle cell disease (SCD) patients who were frequent utilizers of urgent or emergent care resources from low-utilizing patients. METHODS Patients at a large urban comprehensive SCD treatment center were recruited from clinic or during urgent care visits. Participants who were high utilizers, defined as having >4 acute or emergency care visits in the prior 12 months, were compared with patients with more typical utilization patterns on lifetime complications of SCD, family background, psychiatric history, occupational function, coping, depressive symptoms, and personality. RESULTS High utilizers were nearly a decade younger on average; despite this they had a similar lifetime history of SCD complications. High-utilizing patients' parents seemed to have greater educational achievement overall. High utilizers reported a nearly 3-fold greater prevalence of psychiatric illness in family members than low utilizers. On other measures, including coping strategies, social support, and personality, the 2 groups were comparable. DISCUSSION The study strengthens emerging evidence that disease severity, familial factors related to greater parental education, and psychiatric illness are important factors in high care utilization in patients with SCD.
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Affiliation(s)
- Patrick C Carroll
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, MA, USA.
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Barrera TL, Hiatt EL, Dunn NJ, Teng EJ. Impact of panic disorder on quality of life among veterans in a primary care pilot study. Compr Psychiatry 2013; 54:256-61. [PMID: 23102729 DOI: 10.1016/j.comppsych.2012.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/24/2012] [Accepted: 09/13/2012] [Indexed: 11/30/2022] Open
Abstract
Panic disorder is a debilitating and costly mental health condition which commonly presents in primary care settings; however, little is known about the impact of panic disorder on quality of life and health utility valuations among Veterans in primary care. A cross-sectional investigation of quality of life was conducted in a sample of 21 Veterans with panic disorder in a VA primary care clinic. Health utilities were determined using an algorithm based upon the Medical Outcomes Study Short-Form 36 Health Survey (SF-36). Veterans in the current sample reported significantly greater impairment on all eight of the SF-36 subscales in comparison to published norms. Veterans with panic and comorbid mood disorders reported significantly greater impairment on the Vitality, Social Functioning, and Mental Health subscales, while Veterans with panic and comorbid anxiety disorders reported significantly greater impairment on the Physical Functioning and Bodily pain subscales. Health utilities for the current sample were comparable to previous reports of Veterans with PTSD and depression, as well as health utilities of persons with chronic pulmonary disease and irritable bowel syndrome. The findings from this study highlight the devastating nature of panic disorder and reflect the need for increased attention to the identification and treatment of panic disorder in VA primary care settings.
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Affiliation(s)
- Terri L Barrera
- Michael E. DeBakey Veterans Affairs (VA) Medical Center, 116 MHCL, Houston, TX 77030, USA
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May AC, Rudy BM, Davis TE, Matson JL. Evidence-Based Behavioral Treatment of Dog Phobia With Young Children. Behav Modif 2012; 37:143-60. [DOI: 10.1177/0145445512458524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Specific phobias are among the most common anxiety disorders, especially in children. Unfortunately, a paucity of literature exists regarding the treatment of specific phobia in young children, despite the knowledge that traditional techniques (i.e., cognitive-behavioral therapy [CBT]) may not be practical. Therefore, the purpose of this article is to present two case studies that provide empirical support for the evidence-based behavioral treatment of specific phobia with young children (ages 4 and 5 years). Results indicated that following 10 to 13 sessions of graduated exposure therapy using reinforced practice and participant modeling, the children no longer met criteria for clinically significant phobias of dogs. Treatment effects were maintained at 7-month follow-up despite reported lack of practice and/or regular exposure to dogs in the children’s daily lives.
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Affiliation(s)
- Anna C. May
- Louisiana State University, Baton Rouge, USA
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Lee H, Turkel JE, Cotter SP, Milliken JM, Cougle J, Goetz AR, Lesnick AM. Attentional bias toward personally relevant health-threat words. ANXIETY STRESS AND COPING 2012; 26:493-507. [PMID: 22881238 DOI: 10.1080/10615806.2012.713474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Conflicting findings have emerged regarding the presence of attentional biases (ABs) in health anxiety, probably due to methodological limitations in the stimuli used in cognitive tasks and the assessment of health anxiety-relevant factors. The current study sought to examine ABs toward health-related threats using idiographically chosen health-threat words in a non-clinical sample. A modified dot-probe task using idiographically selected health-threat words was administered to an undergraduate sample. Self-report measures were administered to assess somatic, cognitive, and behavioral aspects of health anxiety, in addition to assessing negative affect, anxiety sensitivity, and experience of actual medical conditions. Results showed that behavioral and somatic aspects of health anxiety were significantly associated with AB toward personally relevant threat words, even after controlling for negative affect, anxiety sensitivity, and experience of actual medical conditions. Additional analyses revealed that these biases reflected difficulty disengaging attention from threat rather than a facilitated detection of threat. In contrast, illness-related cognitions were found to be unrelated to ABs. These findings suggest an association between threat-related ABs and excessive health-care seeking efforts.
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Affiliation(s)
- Hanjoo Lee
- a Department of Psychology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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Fond G, Franc N. [Treating specific childhood phobia in a single session? A systematic review of the literature]. Encephale 2012; 39:109-14. [PMID: 23095586 DOI: 10.1016/j.encep.2012.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 01/25/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The essential feature of specific phobia is a persistent fear of clearly discernable, circumscribed objects or situations. The DSM-IV distinguishes four subtypes: animal, natural environment, blood-injection-injury, and situational. Specific phobias frequently co-occur. Specific phobia is one of the most common psychiatric disorders with a lifetime prevalence of 12.5% and is about twice as common in women as in men. Most phobias have a childhood onset except for the situational subtype which usually occurs during patients' twenties. It is well known that childhood anxiety increases the risk of psychiatric disorders such as depression and anxiety in later life, as well as the risk of suicide attempts and psychiatric hospitalization. Nonetheless, there are few studies on the psychobiology and pharmacotherapy of specific phobias. Neuroimaging studies have shown that specific phobia seems to be associated with amygdala (more specifically the right amygdala) and anterior cingulate cortex hyperactivation that is reduced after exposure therapy. The aim of this study is to propose the first systematic review of specific phobia treatment among children. METHOD The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Two databases (Medline and Web of Science) were searched combining the search terms: specific phobia and treatment. English and French language were imposed. There were no publication date or publication status limitations. Seventy-four studies met the inclusion criteria and 36 were included. RESULTS The goal of treatment is to achieve habituation and eventual extinction of the phobic reaction. Treatments for children's anxiety have been suggested to work through diverse processes such as counter-conditioning, extinction, habituation, change in catastrophic cognitions, development of coping skills, increased self-efficacy, emotional processing, and changes in expectancies and perceptions of dangerousness. Most phobias respond robustly to in vivo exposure, but this approach is associated with high dropout rates and low treatment acceptance. One Session Treatment, a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. The limited data available on medication shows little promise. Finally, relapse is a common phenomenon, and little is known on the long-term outcome of the illness.
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Affiliation(s)
- G Fond
- Université Montpellier 1, 34006 Montpellier, France.
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