1
|
Tabrizi FF, Larsson AB, Grönvall H, Söderstrand L, Hallén E, Champoux-Larsson MF, Lundgren T, Sundström F, Lavefjord A, Buhrman M, Sundin Ö, McCracken L, Åhs F, Jansson B. Psychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI). Cogn Behav Ther 2022:1-22. [PMID: 36562150 DOI: 10.1080/16506073.2022.2153077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychiatric disorders are common, and reliable measures are crucial for research and clinical practice. A cross-diagnostic construct that can be used to index treatment outcomes as well as prevalence of psychological ill health is psychological flexibility. The aim of this study was to validate a Swedish version of the Multidimensional Psychological Flexibility Inventory (MPFI). The MPFI has 12 subscales, six of which measure flexibility, and six that measure inflexibility. Using confirmatory factor analysis in a community sample of 670 participants, we found that a model with two higher order factors had satisfactory fit (CFI = .933) and a 12-factor model had the best fit to the data (CFI = .955). All 12 subscales showed adequate reliability (CRs = .803-.933) and the factor structure was similar across age groups and gender. Findings suggest that the Swedish version of the MPFI is a reliable instrument that can be used to index psychological flexibility. Potential areas for improvement of the instrument are discussed.
Collapse
Affiliation(s)
- Fara F Tabrizi
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Andreas B Larsson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Hampus Grönvall
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lux Söderstrand
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Ellen Hallén
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | | | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Felicia Sundström
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Amani Lavefjord
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Örjan Sundin
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lance McCracken
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Fredrik Åhs
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Billy Jansson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| |
Collapse
|
2
|
Turi ER, Reigada LC, Liu J, Leonard SI, Bruzzese JM. Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Ann Allergy Asthma Immunol 2021; 127:661-666.e1. [PMID: 34547441 PMCID: PMC8627490 DOI: 10.1016/j.anai.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.
Collapse
Affiliation(s)
- Eleanor R Turi
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Laura C Reigada
- Department of Psychology, Brooklyn College and The Graduate Center, The City University of New York, New York, New York
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Sarah I Leonard
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York.
| |
Collapse
|
3
|
Putwain DW, Stockinger K, von der Embse NP, Suldo SM, Daumiller M. Test anxiety, anxiety disorders, and school-related wellbeing: Manifestations of the same or different constructs? J Sch Psychol 2021; 88:47-67. [PMID: 34625210 DOI: 10.1016/j.jsp.2021.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/15/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Previous studies have shown that highly test anxious persons are more likely to meet criteria for an anxiety disorder and report more frequent symptoms of anxiety disorders than their low test anxious counterparts. However, it is unclear whether test anxiety should be treated as distinct to, or a manifestation of, anxiety disorders. Furthermore, the Dual Factor Model of Mental Health proposes that high subjective wellbeing cannot be solely inferred from the absence of psychopathology. To date, no studies have examined the Dual Factor Model in relation to test anxiety. In the present study, we examined how test anxiety, two common anxiety disorders (i.e., generalized anxiety disorder [GAD] and panic disorder [PD]), and subjective wellbeing in the school domain (i.e., school-related wellbeing) were related in a sample of 918 adolescents (M age = 15.77 years) using network analysis and latent profile analysis. Results from the network analysis indicated that test anxiety, GAD, PD, and school-related wellbeing were represented as distinct constructs. Bridge nodes were identified that linked test anxiety with GAD, PD, and school-related wellbeing. The latent profile analysis identified three of the four profiles predicted by the Dual Factor Model, including (a) troubled (i.e., low school-related wellbeing, high test anxiety, GAD, and PD), (b) complete mental health (i.e., high school-related wellbeing, low test anxiety, GAD, and PD), and (c) symptomatic but content (i.e., average school-related wellbeing, test anxiety, GAD, and PD). We concluded that test anxiety was distinct from, rather than a manifestation of, GAD and PD. We found support for the Dual Factor Model, albeit not unequivocal, using test anxiety as an additional indicator of psychopathology to that of GAD and PD.
Collapse
Affiliation(s)
- David W Putwain
- School of Education, Liverpool John Moores University, Liverpool, UK.
| | | | | | | | - Martin Daumiller
- Department of Psychology, University of Augsburg, Augsburg, Germany
| |
Collapse
|
4
|
López PL, Ciapponi A, Compte EJ, Comandé D, Murray S, Ailan D, Torrente FM. Transdiagnostic versus specific cognitive-behavioral treatments for adults with anxiety disorders. Hippokratia 2020. [DOI: 10.1002/14651858.cd013735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pablo Luis López
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT); CONICET, INECO Foundation, Favaloro University; Buenos Aires Argentina
| | - Agustín Ciapponi
- Argentine Cochrane Centre; Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET); Buenos Aires Argentina
| | | | - Daniel Comandé
- Argentine Cochrane Centre; Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET); Buenos Aires Argentina
| | - Stuart Murray
- Department of Psychiatry & Behavioral Sciences; University of Southern California; Los Angeles California USA
| | - Delfina Ailan
- Psychiatry and Cognitive Psychotherapy; Institute of Cognitive Neurology (INECO); Buenos Aires Argentina
| | - Fernando Manuel Torrente
- Laboratory of Psychopathology Research, Institute of Cognitive and Translational Neuroscience (INCyT); CONICET, INECO Foundation, Favaloro University; Buenos Aires Argentina
| |
Collapse
|
5
|
Sakiris N, Berle D. A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clin Psychol Rev 2019; 72:101751. [DOI: 10.1016/j.cpr.2019.101751] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 01/19/2023]
|
6
|
Labbe AK, Wilner JG, Coleman JN, Marquez SM, Kosiba JD, Zvolensky MJ, Smits JAJ, Norton PJ, Rosenfield D, O'Cleirigh C. A qualitative study of the feasibility and acceptability of a smoking cessation program for people living with HIV and emotional dysregulation. AIDS Care 2019; 31:609-615. [PMID: 30350712 PMCID: PMC6408255 DOI: 10.1080/09540121.2018.1533225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022]
Abstract
Despite high rates of co-occurring tobacco use and anxiety among persons living with HIV, evidence-based interventions for these individuals are limited. An existing cognitive-behavioral treatment protocol for smoking cessation and anxiety (Norton, P. J., & Barrera, T. L. (2012). Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depression and Anxiety, 29(10), 874-882. https://doi.org/10.1002/da.21974) was modified to address transdiagnostic constructs, such as anxiety sensitivity, distress tolerance, and depressive symptomatology (Labbe, A. K., Wilner, J. G., Kosiba, J. D., Gonzalez, A., Smits, J. A., Zvolensky, M. J., … O'Cleirigh, C. (2017). Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People with HIV: A Clinical Case Study. Cognitive and Behavioral Practice, 24(2), 200-214. https://doi.org/10.1016/j.cbpra.2016.03.009). This study examines the feasibility and acceptability of the intervention as determined from qualitative data from structured exit interviews from 10 participants who completed treatment. Results demonstrated that participants were very motivated to quit smoking and enrolled in the program for health-related reasons and to be able to quit. Participants found nearly all the treatment components to be useful for reaching their smoking cessation goal and in managing emotional dysregulation. Last, all participants stated that they would strongly recommend the treatment program. This qualitative study provides initial evidence for the feasibility and acceptability of a modified smoking cessation treatment protocol for HIV+ individuals with anxiety and emotional dysregulation. Future research will focus on evaluating the efficacy of the protocol in a full-scale randomized controlled trial, as well as working to collect qualitative data from participants who discontinue treatment to better understand reasons for treatment attrition.
Collapse
Affiliation(s)
- A K Labbe
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - J G Wilner
- b Dept. of Psychology , Boston University , Boston , MA , USA
| | - J N Coleman
- c Dept. of Psychology , Duke University , Raleigh , NC , USA
| | - S M Marquez
- d The Fenway Institute , Fenway Health , Boston , MA , USA
| | - J D Kosiba
- e Dept. of Psychology , Syracuse University , Syracuse , NY , USA
| | - M J Zvolensky
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - J A J Smits
- g Dept. of Psychology , University of Texas at Austin , Austin , TX , USA
| | - P J Norton
- f Dept. of Psychology , University of Houston , Houston , TX , USA
| | - D Rosenfield
- h Dept. of Psychology , Southern Methodist University , Dallas , TX , USA
| | - C O'Cleirigh
- a Dept. of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
- d The Fenway Institute , Fenway Health , Boston , MA , USA
| |
Collapse
|
7
|
Roberge P, Provencher MD, Gosselin P, Vasiliadis HM, Gaboury I, Benoit A, Antony MM, Chaillet N, Houle J, Hudon C, Norton PJ. A pragmatic randomized controlled trial of group transdiagnostic cognitive-behaviour therapy for anxiety disorders in primary care: study protocol. BMC Psychiatry 2018; 18:320. [PMID: 30285672 PMCID: PMC6169021 DOI: 10.1186/s12888-018-1898-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental disorders in community settings, and they are associated with significant psychological distress, functional and social impairment. While cognitive behaviour therapy (CBT) is the most consistently efficacious psychological treatment for anxiety disorders, barriers preclude widespread implementation of CBT in primary care. Transdiagnostic group CBT (tCBT) focuses on cognitive and behavioural processes and intervention strategies common to different anxiety disorders, and could be a promising alternative to conventional CBT. This study aims to examine the effectiveness of a transdiagnostic group CBT for anxiety disorders program as a complement to treatment-as-usual (TAU) in primary mental health care. METHODS/DESIGN The trial is a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment, and follow-up at 4, 8 and 12-months design. Treatment and control groups. a) tCBT (12 weekly 2-h group sessions following a manualized treatment protocol); b) TAU for anxiety disorders. Inclusion criteria comprise meeting DSM-5 criteria for primary Panic Disorder, Agoraphobia, Social Anxiety Disorder and/or Generalized Anxiety Disorder. Patients are recruited in three regions in the province of Quebec, Canada. The primary outcome measures are the self-reported Beck Anxiety Inventory and the clinician-administered Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5); secondary outcome measures include treatment responder status based on the ADIS-5, and self-reported instruments for specific anxiety and depression symptoms, quality of life, functioning, and service utilisation. STATISTICAL ANALYSIS Intention-to-treat analysis. A mixed effects regression model will be used to account for between- and within-subject variations in the analysis of the longitudinal effects of the intervention. DISCUSSION This rigorous evaluation of tCBT in the real world will provide invaluable information to decision makers, health care managers, clinicians and patients regarding the effectiveness of the intervention. Widespread implementation of tCBT protocols in primary care could lead to better effectiveness, efficiency, access and equity for the large number of patients suffering from anxiety disorders that are currently not obtaining evidence-based psychotherapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458 .
Collapse
Affiliation(s)
- Pasquale Roberge
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin D Provencher
- École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Université Laval, Québec, QC G1V 0A6 Canada
| | - Patrick Gosselin
- Institut universitaire de première ligne en santé et services sociaux (CIUSSS de l’Estrie- CHUS), Department of Psychology, Université de Sherbrooke, 2500, boulevard de l’Université, Sherbrooke, QC J1K 2R1 Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Centre de recherche Hôpital Charles LeMoyne, 3120, boul. Taschereau, Greenfield Park, QC J4V 2H1 Canada
| | - Isabelle Gaboury
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Annie Benoit
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - Nils Chaillet
- Department of Obstetrics, Gynecology, and Reproduction, Université Laval, 2705, boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC H3C 3P8 Canada
| | - Catherine Hudon
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4 Canada
| | - Peter J Norton
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC 3800 Australia
| |
Collapse
|
8
|
Harris KR, Norton PJ. Transdiagnostic Cognitive Behavioral Therapy for the Treatment of Emotional Disorders: A Group Case Study. Clin Case Stud 2018. [DOI: 10.1177/1534650118793938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A recent shift in the conceptualization of both depressive and anxiety disorders supports the notion that these disorders may best fall under a single classification of “emotional disorders.” This understanding has resulted in the development of various transdiagnostic cognitive behavioral therapy (tCBT) protocols to address underlying core pathology shared by emotional disorders. While there is evidence to suggest tCBT is effective in reducing co-occurring depression, research into the efficacy of face-to-face tCBT has generally focused on the delivery of tCBT to individuals with predominantly anxiety diagnoses. The current case study aims to expand the research by examining the impact of group tCBT for individuals with a principal depressive diagnosis. A session-by-session explanation of a 12-week group tCBT protocol designed to treat a heterogeneous group of individuals diagnosed with an emotional disorder is provided in detail and accompanied by a quantitative case study of a recently delivered treatment group. The case study demonstrates the feasibility and pragmatic application of the group tCBT treatment approach. Data presented support the continued research of transdiagnostic interventions for the treatment of emotional disorders and justify future randomized controlled trials to further evaluate the presented intervention.
Collapse
|
9
|
Abstract
Transdiagnostic cognitive-behavioral (CBT) therapy is a modified form of CBT designed to be applicable with patients across the range of anxiety and related emotional disorders. Based on emerging genetic, neurologic, developmental, cognitive, and behavioral science, transdiagnostic CBT may alleviate barriers to dissemination and accessibility by providing a single treatment approach across diagnoses. Data from clinical trials and metaanalyses suggest treatment efficacy that is comparable with traditional CBT approaches, with possibly superior efficacy among patients with multiple comorbid anxiety and emotional diagnoses. Limitations in the evidence base and remaining areas for future research are discussed.
Collapse
|
10
|
Norton PJ, Paulus DJ. Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings. Clin Psychol Rev 2017; 56:122-137. [DOI: 10.1016/j.cpr.2017.03.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/07/2017] [Accepted: 03/21/2017] [Indexed: 01/18/2023]
|
11
|
Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
12
|
Pearl SB, Norton PJ. Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. J Anxiety Disord 2017; 46:11-24. [PMID: 27466074 DOI: 10.1016/j.janxdis.2016.07.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/21/2022]
Abstract
Research evaluating transdiagnostic CBT (tCBT) demonstrates its efficacy. Some evidence suggests equivalence between tCBT and diagnosis-specific CBT (dxCBT), however more investigations are necessary to clarify any difference in efficacy. This meta-analysis was conducted to compare tCBT and dxCBT, and to investigate the differential impact of comorbidity on effect sizes. Pre and post scores from primary anxiety measures in 83 treatment conditions, taken from studies primarily targeting anxiety disorders, were summarised and compared. Meta-regression analyses were then used to test the effects of comorbidity. DxCBT and tCBT meta-effects were found to be large, where g=0.951, 95% CI: 0.874-1.027, and g=1.059, 95% CI: 0.876-1.242, respectively. While statistically different (p=0.008), overlap of confidence intervals indicated a lack of clinical significance. Furthermore, no relationship between comorbidity rate and tCBT outcome was observed. These results were discussed in the context of previous findings in the transdiagnostic CBT literature.
Collapse
Affiliation(s)
- Shaun B Pearl
- School of Psychological Sciences, Clayton, Victoria, Australia
| | - Peter J Norton
- School of Psychological Sciences, Clayton, Victoria, Australia.
| |
Collapse
|
13
|
Affiliation(s)
- Peter Norton
- Monash University, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| |
Collapse
|
14
|
Talkovsky AM, Green KL, Osegueda A, Norton PJ. Secondary depression in transdiagnostic group cognitive behavioral therapy among individuals diagnosed with anxiety disorders. J Anxiety Disord 2017; 46:56-64. [PMID: 27707524 DOI: 10.1016/j.janxdis.2016.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Abstract
Anxiety and depression co-occur at high rates, and their comorbidity typically creates a more severe clinical presentation then either alone. The effect of comorbid depression appears to vary across anxiety and related disorders. Transdiagnostic treatments present a promising option to improve comorbid conditions by targeting shared factors (e.g., information processing biases). The purpose of this study was to examine the reciprocal effects of secondary depression in transdiagnostic group cognitive behavioral therapy for anxiety (TGCBT). 120 individuals diagnosed with a primary anxiety disorder, 42 of whom had a depressive diagnosis, were enrolled in 12 weeks of TGCBT. Depressed individuals were compared to those without a depressive diagnosis on both clinician-rated and self-reported anxiety and depression following TGCBT. Although depressed individuals scored higher on most indices of anxiety at pre-treatment, both groups improved similarly with some evidence of greater improvement among those with comorbid depression. All individuals improved in self-reported depressive symptoms and comorbid depression improved to subclinical levels. These results posit TGCBT as an effective, efficient option for treating patients with anxiety and comorbid depression.
Collapse
|
15
|
Norton PJ, Paulus DJ. Toward a Unified Treatment for Emotional Disorders: Update on the Science and Practice. Behav Ther 2016; 47:854-868. [PMID: 27993337 DOI: 10.1016/j.beth.2015.07.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/25/2015] [Accepted: 07/07/2015] [Indexed: 12/21/2022]
Abstract
Mental health professionals have long been concerned with describing and proscribing a structure around the myriad variations of psychological and emotional distress that are deemed to be disordered. This has frequently been characterized as a conflict between so-called "lumpers" and "splitters"-those who advocate broad categorizations based on overarching commonalities versus those who endeavor toward a highly refined structure emphasizing unique characteristics. Many would argue that with the era of the modern Diagnostic and Statistical Manual of Mental Disorders (DSM-III to DSM-5), a splitting ideology has been dominant despite re-emerging concerns that some groups of diagnoses, particularly disorders of anxiety and other emotions, may be more similar than different. As a result of such concerns, transdiagnostic or unified models of psychopathology have burgeoned. In this review, we describe the work of Barlow, Allen, and Choate (2004), whose invited paper "Toward a Unified Treatment for Emotional Disorders" reignited transdiagnostic perspectives of emotional disorders. We provide an update on the scientific models and evidence-based treatments that have followed in the wake of this 2004 publication, including key areas for future study in the advancement of transdiagnostic and unified treatment of emotional disorders.
Collapse
|
16
|
Holas P, Suszek H. Group Process and Therapeutic Protocol of Intensive Transdiagnostic Group Cognitive-Behavioral Therapy for Anxiety and Personality Disorders in a Day Clinic. Int J Group Psychother 2016; 66:422-430. [PMID: 38449128 DOI: 10.1080/00207284.2016.1156405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This brief report presents group processes and the treatment protocol of intensive, transdiagnostic group cognitive-behavior therapy for anxiety with comorbid personality disorders in a day clinic. It describes the history of and rationale for the development of this 3-month, 15-hour a week group treatment and the utilization of group processes during this therapy. The authors argue that the group format presented here allows the treatment of personality disorders that are frequently comorbid with anxiety disorders.
Collapse
|
17
|
Holas P, Suszek H, Szaniawska M, Kokoszka A. Group Cognitive-Behavioral Therapy for Anxiety Disorders With Personality Disorders in Day Clinic Setting. Perspect Psychiatr Care 2016; 52:186-93. [PMID: 25817744 DOI: 10.1111/ppc.12115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/26/2015] [Accepted: 02/19/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Short-term group cognitive-behavioral therapy (GCBT) with weekly homogeneous group sessions for treating specific anxiety disorders is relatively well developed and recognized. However, 12 weeks of intensive daily therapy for mixed anxiety and personality disorders is not. The current article aims to fill this gap by presenting the method of intensive transdiagnostic GCBT for anxiety disorders with comorbid personality disorders in a day hospital setting. Preliminary studies showed that participants exhibited significant improvement during this type of treatment. CONCLUSIONS This article reviews the advantages of group therapy that is transdiagnostic over the homogeneous group and individual therapy formats. PRACTICE IMPLICATIONS The detailed description of the current therapeutical program may facilitate the development of similar programs in day clinic settings.
Collapse
Affiliation(s)
- Pawel Holas
- Psychology Department, University of Warsaw, Warsaw, Poland
| | - Hubert Suszek
- Psychology Department, University of Warsaw, Warsaw, Poland
| | - Monika Szaniawska
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
18
|
Smith AH, Paulus DJ, Norton PJ. Transdiagnostic assessment of anxiety symptoms using the Anxiety Disorder Diagnostic Questionnaire - weekly version. ANXIETY STRESS AND COPING 2016; 30:96-106. [PMID: 27229362 DOI: 10.1080/10615806.2016.1186272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Norton and Robinson [2010. Development and evaluation of the anxiety disorder diagnostic questionnaire. Cognitive Behaviour Therapy, 39(2), 137-149. doi: 10.1080/16506070903140430 ] developed the Anxiety Disorder Diagnostic Questionnaire (ADDQ) as a transdiagnostic assessment of fear and anxiety to address problems in using diagnosis-specific measures as well as limitations with the extant transdiagnostic measures of anxiety. The present study validated a weekly version of the ADDQ, the Anxiety Disorder Diagnostic Questionnaire - Weekly (ADDQ-W) allowing session-by-session transdiagnostic assessment of anxiety. METHOD Data were a secondary analysis of 49 treatment-seeking outpatient adults from a previous clinical trial. The ADDQ-W was administered weekly over the course of 12-group therapy sessions. RESULTS The ADDQ-W was a valid weekly measure and neither scores, F(2, 37) = 2.70, p = .08, nor trajectories of change, F(2, 37) = 0.31, p = .73, differed by primary diagnosis, though power was limited. Rate of ADDQ-W change was predictive of change in both primary diagnosis severity, t = 2.40, p = .02, β = 0.32, and overall severity, t = 3.01, p < .01, β = 0.36, at post-treatment. CONCLUSIONS This study has established initial support for the use of the brief, easily scored, ADDQ-W for repeated assessment over treatment using a diagnostically heterogeneous clinical sample of treatment-seeking individuals.
Collapse
Affiliation(s)
- Angela H Smith
- a Michael E. DeBakey Veterans Affairs Medical Center , Houston , TX , USA
| | - Daniel J Paulus
- b Department of Psychology , University of Houston , Houston , TX , USA
| | - Peter J Norton
- c Department of Psychology , Monash University , Melbourne , Australia
| |
Collapse
|
19
|
Paulus DJ, Norton PJ. Purging Anxiety: A Case Study of Transdignostic CBT for a Complex Fear of Vomiting (Emetophobia). COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
20
|
Hovenkamp-Hermelink JH, Riese H, van der Veen DC, Batelaan NM, Penninx BW, Schoevers RA. Low stability of diagnostic classifications of anxiety disorders over time: A six-year follow-up of the NESDA study. J Affect Disord 2016; 190:310-315. [PMID: 26544613 DOI: 10.1016/j.jad.2015.10.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stability of diagnosis was listed as an important predictive validator for maintaining separate diagnostic classifications in DSM-5. The aim of this study is to examine the longitudinal stability of anxiety disorder diagnoses, and the difference in stability between subjects with a chronic versus a non-chronic course. METHODS Longitudinal data of 447 subjects with a current pure anxiety disorder diagnosis at baseline from the Netherlands Study of Depression and Anxiety were used. At baseline, 2-, 4-, and 6-year follow-up mental disorders were assessed and numbers (and percentages) of transitions from one anxiety disorder diagnosis to another were determined for each anxiety disorder diagnosis separately and for subjects with a chronic (i.e. one or more anxiety disorder at every follow-up assessment) and a non-chronic course. RESULTS Transition percentages were high in all anxiety disorder diagnoses, ranging from 21.1% for social anxiety disorder to 46.3% for panic disorder with agoraphobia at six years of follow-up. Transition numbers were higher in the chronic than in the non-chronic course group (p=0.01). LIMITATIONS Due to the 2 year sample frequency, the number of subjects with a chronic course may have been overestimated as intermittent recovery periods may have been missed. CONCLUSIONS These data indicate that anxiety disorder diagnoses are not stable over time. The validity of the different anxiety disorder categories is not supported by these longitudinal patterns, which may be interpreted as support for a more pronounced dimensional approach to the classification of anxiety disorders.
Collapse
Affiliation(s)
- Johanna Hm Hovenkamp-Hermelink
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands.
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
| | - Date C van der Veen
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
| | - Neeltje M Batelaan
- Department of Psychiatry and EMGO Institute of Health and Care Research, VU University Medical Center Amsterdam, the Netherlands; GGZ inGeest, Amsterdam, the Netherlands
| | - Brenda Wjh Penninx
- Department of Psychiatry and EMGO Institute of Health and Care Research, VU University Medical Center Amsterdam, the Netherlands; GGZ inGeest, Amsterdam, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
| |
Collapse
|
21
|
Newby JM, McKinnon A, Kuyken W, Gilbody S, Dalgleish T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev 2015; 40:91-110. [DOI: 10.1016/j.cpr.2015.06.002] [Citation(s) in RCA: 326] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 01/27/2023]
|
22
|
Suszek H, Holas P, Wyrzykowski T, Lorentzen S, Kokoszka A. Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial. Trials 2015; 16:319. [PMID: 26220089 PMCID: PMC4517633 DOI: 10.1186/s13063-015-0827-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/29/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study. METHODS/DESIGN In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following the end of therapy. DISCUSSION The rationale is to investigate how effectively anxiety disorders and/or comorbid depressive or personality disorders can be treated in a day hospital setting, typical of the Polish health care system, during a three-month treatment period. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02126787 , registered on 28 April 2014.
Collapse
Affiliation(s)
- Hubert Suszek
- Faculty of Psychology, University of Warsaw, Ul. Stawki 5/7, 00-183, Warsaw, Poland.
| | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Ul. Stawki 5/7, 00-183, Warsaw, Poland.
| | | | - Steinar Lorentzen
- Institute of Clinical Medicine, University of Oslo, PO Box 1039, , Blindern, Oslo, 0315, Norway.
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland.
| |
Collapse
|
23
|
Talkovsky AM, Norton PJ. Mediators of transdiagnostic group cognitive behavior therapy. J Anxiety Disord 2014; 28:919-24. [PMID: 25445082 DOI: 10.1016/j.janxdis.2014.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/15/2014] [Accepted: 09/26/2014] [Indexed: 01/04/2023]
Abstract
The efficacy of cognitive-behavioral therapy (CBT) for anxiety is well established. Investigations into the mechanisms of change in CBT report changes in cognitive vulnerabilities mediating improvements over the course of treatment. As anxiety disorders share certain risk factors, there is a trend toward CBT emphasizing these vulnerabilities, including negative affectivity (NA) and also more specific constructs such as anxiety sensitivity (AS) and intolerance of uncertainty (IU). The purpose of this investigation was to analyze potential mediators of anxiety reduction over the course of transdiagnostic group CBT. NA, AS, and IU all decreased over the course of treatment. Among the potential mediators, change in NA had a significant relationship with change in anxiety but change in AS and change in IU did not. Neither the main effect of primary diagnosis nor the interactions between potential mediators and primary diagnoses were significant, indicating that there were no differential changes in anxiety or the potential mediators across primary diagnoses. Results strongly point toward NA as an overarching mediator of anxiety reduction during transdiagnostic group CBT.
Collapse
|
24
|
Reinholt N, Krogh J. Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cogn Behav Ther 2014; 43:171-84. [PMID: 24646219 DOI: 10.1080/16506073.2014.897367] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transdiagnostic approaches to cognitive behaviour therapy (TCBT) of anxiety disorders have drawn increasing interest and empirical testing over the past decade. In this paper, we review evidence of the overall efficacy of TCBT for anxiety disorders, as well as TCBT efficacy compared with wait-list, treatment-as-usual, and diagnosis-specific cognitive behaviour therapy (CBT) controls. A total of 11 studies reporting 12 trials (n = 1933) were included in the systematic review. Results from the meta-analysis of 11 trials suggest that TCBT was generally associated with positive outcome; TCBT patients did better than wait-list and treatment-as-usual patients, and treatment gains were maintained through follow-up. The pooled estimate showed a moderate treatment effect, however with large heterogeneity suggesting differences in treatment effects between the studies. Also, all the included trials, apart from one, were judged to be associated with a high risk of bias. Only one study compared TCBT with diagnosis-specific CBT suggesting treatment effect of TCBT to be as strong as diagnosis-specific CBT. This study not only cautiously supports evidence for the efficacy of TCBT, but also suggests the need for more high-quality, large-scaled studies in this area. Transdiagnostic treatments offer great clinical promise as an affordable and pragmatic treatment for anxiety disorders and as a specialized treatment for co-morbid and other-specified anxiety disorders.
Collapse
Affiliation(s)
- Nina Reinholt
- a Mental Health Centre Copenhagen, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | | |
Collapse
|
25
|
Chamberlain LD, Norton PJ. An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety. Cogn Behav Ther 2013; 42:56-63. [DOI: 10.1080/16506073.2012.748090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific cbt for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depress Anxiety 2012; 29:874-82. [PMID: 22767410 PMCID: PMC3463777 DOI: 10.1002/da.21974] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/16/2012] [Accepted: 06/03/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Transdiagnostic cognitive-behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions. METHODS The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group Cognitive-Behavioral Therapy (CBT) protocols for panic disorder, social anxiety disorder, and generalized anxiety disorder. RESULTS Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility. CONCLUSIONS This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxiety disorder, generalized anxiety disorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence-based treatments for anxiety without sacrificing efficacy.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston, Houston, Texas 77204-5022, USA.
| | | |
Collapse
|
27
|
Norton PJ. A randomized clinical trial of transdiagnostic cognitve-behavioral treatments for anxiety disorder by comparison to relaxation training. Behav Ther 2012; 43:506-17. [PMID: 22697440 PMCID: PMC3484173 DOI: 10.1016/j.beth.2010.08.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/19/2010] [Accepted: 08/24/2010] [Indexed: 01/23/2023]
Abstract
Transdiagnostic cognitive-behavioral treatments (CBT) for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, all of the research on transdiagnostic anxiety treatments to date have either not used a control condition, or have relied on no-treatment or delayed-treatment controls, thus limiting inferences about comparative efficacy. The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to a 12-week comprehensive relaxation training program. Results from 87 treatment initiators suggested significant and statistically equivalent/noninferior outcomes across conditions, although relaxation was associated with a greater rate of dropout despite no differences in treatment credibility. No evidence was found for any differential effects of transdiagnostic CBT for any primary or comorbid diagnoses.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston,Houston, TX 77204–5022, USA.
| |
Collapse
|
28
|
Mathew AR, Norton PJ, Zvolensky MJ, Buckner JD, Smits JAJ. Smoking Behavior and Alcohol Consumption in Individuals With Panic Attacks. J Cogn Psychother 2011; 25:61-70. [PMID: 21915160 PMCID: PMC3170754 DOI: 10.1891/0889-8391.25.1.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with anxiety often report greater smoking and drinking behaviors relative to those without a history of anxiety. In particular, smoking and alcohol use have been directly implicated among individuals experiencing panic attacks, diagnosed with panic disorder, or high on panic-relevant risk factors such as anxiety sensitivity. Less is known, however, about specific features of panic that may differentiate among those who do or do not use cigarettes or alcohol. The purpose of the current study was to replicate previous research findings of an association between panic symptomatology, cigarette smoking, and alcohol consumption, as well as extend findings by examining whether specific symptoms of panic attacks differentiated among those who do or do not use cigarettes or alcohol. Participants (n = 489) completed the Panic Attack Questionnaire-IV, a highly detailed assessment of panic attacks and symptoms, as well as self-report measures of smoking history and alcohol use. Consistent with previous research, participants who reported a history of panic attacks (n = 107) were significantly more likely to report current daily or lifetime daily cigarette smoking, and significantly greater hazardous or harmful alcohol use than participants with no panic history (n = 382). Although smoking and hazardous alcohol use were highly associated regardless of panic status, participants with panic attacks showed elevated hazardous alcohol use after controlling for daily or lifetime smoking. Surprisingly, although participants who reported having had at least one panic attack were more likely to smoke, panic attack symptoms, intensity, or frequency did not differentiate panickers who did or did not smoke. Furthermore, panic-related variables were not shown to differentially relate to problematic drinking among panickers. Implications for understanding the complex relationship between panic attacks and smoking and drinking behaviors are discussed.
Collapse
|
29
|
McManus F, Shafran R, Cooper Z. What does a transdiagnostic approach have to offer the treatment of anxiety disorders? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 49:491-505. [DOI: 10.1348/014466509x476567] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
30
|
Abstract
A model of anxiety that emphasizes a single common pathology across diagnostic categories is gaining support and influencing nosological and treatment approaches of anxiety disorders. As research in this area continues to grow, a need exists for an assessment tool of the theorized single anxiety pathology that is unbiased toward any particular anxiety diagnosis. The Anxiety Disorder Diagnostic Questionnaire (ADDQ) was developed as a screening tool for the presence of clinical fear and anxiety irrespective of diagnoses. It is a brief four-section index developed to assess fear, anxiety/worry, escape/avoidance behaviors, physiological symptoms, and associated distress and interference. The ADDQ was tested for reliability and validity in two samples: 146 undergraduate students who were given the ADDQ along with a variety of other commonly-used measures of anxiety and 94 outpatients representing a mix of diagnoses (28.2% panic disorder with or without agoraphobia, 44.6% social anxiety disorder, 20.7% generalized anxiety disorder, 3.3% anxiety disorder not otherwise specified, 2.1% obsessive-compulsive disorder, and 1.1% posttraumatic stress disorder). Internal consistency of the instrument was strong, and a one- or two-factor solution was found to be the best fit to the data. Convergent and discriminant validity was also demonstrated. Data from those clinical participants who completed a manualized cognitive-behavioral treatment program indicated a very strong concordance between change on the ADDQ and change in clinician severity ratings from a structured diagnostic interview. The findings offer support for the psychometric validity of the ADDQ in both clinical and nonclinical populations.
Collapse
|
31
|
Serpell L, Waller G, Fearon P, Meyer C. The roles of persistence and perseveration in psychopathology. Behav Ther 2009; 40:260-71. [PMID: 19647527 DOI: 10.1016/j.beth.2008.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/14/2008] [Accepted: 07/23/2008] [Indexed: 11/25/2022]
Abstract
Two constructs were hypothesized to be of importance in psychological disorders: persistence (the ability to keep going to reach a goal, even when the task is difficult or drawn out) and perseveration (the tendency to continue a behavior, even when it ceases to be effective or rewarding). These are contrasted with perfectionism (having high standards for oneself or others). A measure was developed to address these constructs (the Persistence, Perseveration and Perfectionism Questionnaire; PPPQ). The PPPQ was administered to 325 nonclinical participants, alongside a measure of psychological disturbance. Factor analysis resulted in a 22-item version of the measure, consisting of subscales with good psychometric properties corresponding to the 3 theoretical constructs. Persistence was associated with lower levels of psychopathology, whereas perseveration was associated with higher levels of psychopathology. Perfectionism was weakly associated with psychopathology. Further work is needed to develop these constructs with clinical groups, but the findings support the hypothesis that persistence is an adaptive construct whereas perseveration is maladaptive.
Collapse
Affiliation(s)
- Lucy Serpell
- Department of Clinical, Educational & Health Psychology, University College London and Central and North West London NHS Foundation Trust, London.
| | | | | | | |
Collapse
|
32
|
Hayashi S, Hirao A, Nakamura H, Yamamura K, Mizuno K, Yamashita H. Discovery of 1-[1-(1-methylcyclooctyl)-4-piperidinyl]-2-[(3R)-3-piperidinyl]-1H-benzimidazole: integrated drug-design and structure-activity relationships for orally potent, metabolically stable and potential-risk reduced novel non-peptide nociceptin/orphanin FQ receptor agonist as antianxiety drug. Chem Biol Drug Des 2009; 74:369-81. [PMID: 19691471 DOI: 10.1111/j.1747-0285.2009.00872.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Anxiety disorders, caused by continuous or acute stress or fear, have been highly prevailing psychiatric disorders. For the acute treatment of the disorders, benzodiazepines have been widely used despite having liabilities that limit their utility. Alternatively, endogenous nociceptin/orphanin FQ and nociceptin/orphanin FQ peptide receptor (or opioid-receptor-like-1 receptor) have important roles in the integration of emotional components, e.g. anxiolytic activity is the key behavioral action of nociceptin/orphanin FQ in brain. In our preceding study, various structurally novel 1,2-disubstituted benzimidazole derivatives were designed and synthesized as highly potent nociceptin/orphanin FQ peptide receptor selective full agonists in vitro with high or moderate nociceptin/orphanin FQ peptide receptor occupancy in the mice brain per os based on appropriate physicochemical properties for the oral brain activity [Hayashi et al. (2009) J Med Chem;52:610-625]. In the present study, drug design and structure-activity relationships for Vogel anticonflict activities in mice per os, metabolic stabilities in human liver microsome, CYP2D6 inhibitions, serum protein bindings, and human ether-a-go-go related gene binding affinities of novel nociceptin/orphanin FQ peptide receptor agonists were investigated. Through the series of coherent drug discovery studies, the strongest nociceptin/orphanin FQ peptide receptor agonist, 1-[1-(1-methylcyclooctyl)-4-piperidinyl]-2-[(3R)-3-piperidinyl]-1H-benzimidazole was designed and identified as a new-class orally potent anxiolytic with little side-effects, as significant findings.
Collapse
Affiliation(s)
- Shigeo Hayashi
- Pfizer Global Research & Development Nagoya Laboratories, Pfizer Japan Inc, 5-2 Taketoyo, Aichi 470-2393, Japan.
| | | | | | | | | | | |
Collapse
|
33
|
Hayashi S, Hirao A, Imai A, Nakamura H, Murata Y, Ohashi K, Nakata E. Novel non-peptide nociceptin/orphanin FQ receptor agonist, 1-[1-(1-Methylcyclooctyl)-4-piperidinyl]-2-[(3R)-3-piperidinyl]-1H-benzimidazole: design, synthesis, and structure-activity relationship of oral receptor occupancy in the brain for orally potent antianxiety drug. J Med Chem 2009; 52:610-25. [PMID: 19125610 DOI: 10.1021/jm7012979] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An endogenous heptadecapeptide, nociceptin/orphanin FQ (N/OFQ), and a G-protein-coupled receptor, N/OFQ peptide (NOP) receptor [or opioid-receptor-like-1 (ORL1) receptor], have been described in terms of its structure, distribution, and pharmacology. Thus, the N/OFQ and NOP receptor are located in the central nervous systems in humans, primates, and rodents, and are involved in the integration of the emotional components in the brain; e.g., N/OFQ displays anxiolytic activity in the brain. For identifying orally potent anxiolytic, drug-design studies were performed with a series of 1,2-disubstituted benzimidazole derivatives, which resulted in the identification of various chemotypes of highly potent NOP selective full agonists in vitro with high or moderate NOP receptor occupancy in the mice brain per os such as 1-[1-(1-methylcyclooctyl)-4-piperidinyl]-2-[(3R)-3-piperidinyl]-1H-benzimidazole 1 (MCOPPB), the most potent novel non-peptide NOP full agonist in vitro and an orally potent anxiolytic in the mice.
Collapse
Affiliation(s)
- Shigeo Hayashi
- Pfizer Global Research & Development Nagoya Laboratories, Pfizer Japan Inc., 5-2 Taketoyo, Aichi 470-2393, Japan.
| | | | | | | | | | | | | |
Collapse
|
34
|
Philipp LM, Washington C, Raouf M, Norton PJ. Cross‐Cultural Examination of the Tripartite Model in Adults. Cogn Behav Ther 2008; 37:221-32. [DOI: 10.1080/16506070802268175] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
35
|
Norton PJ, Hayes SA, Springer JR. Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety: Outcome and Process. Int J Cogn Ther 2008. [DOI: 10.1521/ijct.2008.1.3.266] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
36
|
Norton PJ. An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behav Ther 2008; 39:242-50. [PMID: 18721638 DOI: 10.1016/j.beth.2007.08.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 08/02/2007] [Accepted: 08/07/2007] [Indexed: 11/28/2022]
Abstract
Transdiagnostic models of anxiety, and cognitive-behavioral treatments based on these models, have been gaining increased attention in recent years. Preliminary efficacy studies generally suggest strong treatment effects, although few of these studies have examined to what extent treatment effects are similar across clients with different anxiety disorders. The purpose of the current study was to examine the efficacy of a 12-week transdiagnostic group cognitive-behavioral therapy for anxiety disorders and compare outcome across diagnoses. Mixed-effect regression modeling of data from 52 participants with anxiety disorders (predominantly panic disorder and social phobia) participating in an open outcome trial indicated that participants tended to improve over treatment, with no differential outcome for any primary or comorbid disorders. The results of this study add to the growing evidence base for transdiagnostic anxiety treatment models and provide preliminary support for the assumption that individuals with different anxiety diagnoses can be treated equally within the same treatment protocol.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, 126 Hyne Bldg., University of Houston, Houston, TX, 77204-5022, USA.
| |
Collapse
|
37
|
Abstract
This article describes a group study of clients partaking in the Anxiety Treatment Protocol (ATP), a 12-week transdiagnostic group cognitive—behavioral therapy (CBT) for individuals with any anxiety disorder. The treatment rationale is briefly described, along with a discussion of the accessibility, dissemination, and therapeutic advantages of delivering transdiagnostic anxiety group treatment. The session-by-session protocol is described in detail, and a quantitative case study of one recent group—and two clients in particular—is presented.
Collapse
|
38
|
Lecrubier Y, Dolberg OT, Andersen HF, Weiller E. Qualitative changes in symptomatology as an effect of treatment with escitalopram in generalized anxiety disorder and major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2008; 258:171-8. [PMID: 18084791 DOI: 10.1007/s00406-007-0771-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 10/01/2007] [Indexed: 11/26/2022]
Abstract
The purpose of this article is to examine the similarities and differences between patients with Major Depressive Disorder (MDD) versus Generalized Anxiety Disorder (GAD) versus MDD with anxiety symptoms. Data were analysed from all randomized double-blind clinical studies with escitalopram that measured symptoms using either Hamilton Anxiety Scale (HAMA) or Montgomery-Asberg Depression Rating Scale (MADRS). The contribution of each item of a scale to the total score was calculated before and after treatment, in remitters. Most single items of the HAMA contribute nearly equally in patients with GAD. In patients with MDD, four symptoms (i.e. anxious mood, tension, insomnia and concentration) contribute to most to the HAMA total score. In patients with GAD, three symptoms (tension, sleep and concentration) contribute two-thirds of the MADRS total score. In contrast, most MADRS items contribute equally to the total score in patients with MDD. After treatment to remission, the profile of residual symptoms MDD or GAD was similar to the symptom profile before treatment. Anxiety symptoms are very common in patients with MDD or GAD, and the symptomatic pattern is similar. In both disorders, the symptomatic pattern of residual symptoms is similar to the pattern of symptoms before treatment.
Collapse
|
39
|
Abstract
The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.
Collapse
Affiliation(s)
- Peter J Norton
- Department of Psychology, University of Houston, Houston, TX 77204-5022, USA
| | | |
Collapse
|