Epidemiologie und nosologischer Status der Generalisierten Angststörung

The adherence/resource priming paradigm--a randomised clinical trial conducting a bonafide psychotherapy protocol for generalised anxiety disorder

BACKGROUND

Bonafide psychotherapy is an effective treatment for generalised anxiety disorder compared to no-treatment. Rather than creating increasing numbers of new overall treatment-packets within a medical meta-model, an additional approach to investigating clinical research designs may be to increase the understanding of already effective psychotherapies. Treatment manuals and protocols allow a relatively high degree of freedom for the way therapists implement the overall treatment manuals. There is a systematic lack of knowledge on how therapists should customise these overall protocols. The present study experimentally examines three ways of conducting a bonafide psychotherapy based on a 15 session time-limited cognitive-behavioural therapy (CBT) protocol and their relation to the therapists' protocol adherence and treatment efficacy.

METHODS/DESIGN

This trial will investigate three different methods of customising a bonafide CBT-protocol using dyadic peer-tutoring methodology (primings). The individuals with GAD will be randomly assigned to one of three priming conditions (resource priming, supportive resource priming, or adherence priming). The participant treatment allocation will be performed randomly. Therapists will be assigned to a peer-tutoring partner and priming condition based on a mutual agreement. Treatment outcomes will be assessed at the following times: observer based in-session outcomes, session-by-session post-session outcomes, treatment outcome at post assessment and treatment outcome at 6-month follow-up.

DISCUSSION

The proposed trial addresses the clinically relevant question of how to customise a bonafide psychotherapy protocol using tandem peer-tutoring methodology (three priming conditions). Through the development and testing of the proposed priming procedures, this study describes levels of adherence and how to conduct an overall treatment protocol in a more systematised way.

TRIAL REGISTRATION

From ClinicalTrials.gov Identifier: NCT02039193.

Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder

BACKGROUND

The behavioral symptoms of Generalized Anxiety Disorder (GAD) are not well characterized. This study examines behavioral symptoms in patients with GAD compared to healthy participants, their change during behavioral therapy, and their role for predicting short- and long-term outcome.

METHODS

Secondary data analysis of 56 patients with DSM-IV GAD from a randomized controlled trial testing worry exposure (n = 29) and applied relaxation (n = 27), compared to 33 demographically matched healthy participants. Participants reported on attempts to control or prevent worry, specifically cognitive and behavioral avoidance, safety behavior, and reassurance, along with other GAD symptoms. The Hamilton Anxiety Scale served as immediate (post therapy) and the Penn State Worry Questionnaire as immediate and long-term (6-/12-month follow-up) treatment outcome measure.

RESULTS

GAD patients engage significantly more in attempts to control or prevent worry as reflected in cognitive and behavioral avoidance, safety behavior, and reassurance seeking than healthy comparison participants. Behavior therapy significantly reduces these behavioral strategies without substantial indication of differential effects of treatment type. However, only patients remitting from GAD reach the low symptom level of healthy participants. The initial level of behavioral symptoms is irrelevant for immediate treatment success, but higher degrees of cognitive and behavioral avoidance and safety behavior at the end of treatment predict worse long-term outcome.

CONCLUSIONS

Behavioral symptoms appear to be relevant features in GAD that improve with successful treatment. Further research is warranted to examine whether inclusion of behavioral symptoms in the definition of GAD would have beneficial effects on diagnostic recognition and treatment.

Psychometrische Gütekriterien des Metakognitionsfragebogens (Kurzversion, MKF-30)

Zusammenfassung. Theoretischer Hintergrund: Metakognitionen wird für das Verständnis verschiedener psychischer Störungen eine wichtige Rolle beigemessen. So kann z.B. übermäßiges Sorgen durch Metakognitionen ausgelöst und aufrechterhalten werden. Fragestellung: Ziel dieser Arbeit war die systematische psychometrische Untersuchung der deutschen Kurzform des Metacognition Questionnaire (MKF-30). Methode: Mittels einer Teilstichprobe (N = 1168) wurde explorativ die Faktorenstruktur des MKF-30 ermittelt. Die ermittelte 5-Faktorenstruktur wurde anschließend konfirmiert (Teilstichprobe 2: N = 1155). Zur Konstruktvalidierung wurden Angst- sowie ein Depressionsfragebogen eingesetzt. Ergebnisse: Es ließen sich die fünf Faktoren des englischen Originals replizieren und konfirmieren. Die Analysen der Itemkennwerte sowie der konvergenten Validität lieferten insgesamt gute Ergebnisse. Schlussfolgerungen: Der MKF-30 kann vorläufig als ein reliables, valides und ökonomisches Instrument zur Erfassung von Metakognitionen angesehen werden.

Anxiety disorders in headache patients in a specialised clinic: prevalence and symptoms in comparison to patients in a general neurological clinic

Data from several studies indicate an association of headache with anxiety disorders. In this study, we assessed and differentiated anxiety disorders in 100 headache patients by using the PSWQ (Penn State Worry Questionnaire) screening tool for generalised anxiety disorder (GAD) and the ACQ (Agoraphobic Cognitions Questionnaire) and BSQ (Body Sensation Questionnaire) for panic disorder (PD). Control groups were constructed: (1) on the basis of epidemiological studies on PD and GAD in the general population and (2) by including neurological patients. 37.0% of headache patients had a GAD. 27% of headache patients met the score for PD in the BSQ, 4.0% in the ACQ. Significant results were obtained in comparison to the general population (p < 0.001) and with regard to GAD in comparison with a sample of neurological patients (p < 0.005). The BSQ significantly correlated with the number of medication days (p < 0.005). The results confirm the increased prevalence of GAD in headache patients. PD seems to increase the risk of medication overuse.

Kreativ? Innovativ? Effizient? Defizient?

Zusammenfassung. Anhand der sorgfältig begutachteten Veröffentlichungen der letzten vier Jahre in der Zeitschrift für Klinische Psychologie und Psychotherapie werden Schwerpunkte und Schwachpunkte, Vielfalt und Einseitigkeit, Bewährung und Mängel, Effizienz und Defizite unseres Fachs deutlich. Diese Übersicht mündet in Anregungen und Wünsche, die sowohl in der Forschung als auch in den Veröffentlichungen Berücksichtigung finden sollten.