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Abstract
We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.
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A Cognitive-Behavioral-Based Workshop Intervention for Maladaptive Perfectionism. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2017. [DOI: 10.1007/s10942-017-0261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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: 106] [Impact Index Per Article: 13.3] [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.
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Barrera TL, Mott JM, Hundt NE, Mignogna J, Yu HJ, Stanley MA, Cully JA. Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders. Gen Hosp Psychiatry 2014; 36:192-8. [PMID: 24268573 DOI: 10.1016/j.genhosppsych.2013.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. METHOD This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. RESULTS Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). CONCLUSION Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings.
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Affiliation(s)
- Terri L Barrera
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center.
| | - Juliette M Mott
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
| | - Natalie E Hundt
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
| | - Joseph Mignogna
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
| | - Hong-Jen Yu
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
| | - Melinda A Stanley
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
| | - Jeffrey A Cully
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; VA South Central Mental Illness Research, Education and Clinical Center
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Harvey AG. A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cogn Behav Ther 2012; 38 Suppl 1:35-42. [PMID: 19697179 DOI: 10.1080/16506070903033825] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sleep disturbance commonly co-occurs with a range of psychiatric disorders. This is of concern given the accruing evidence that sleep is critically important for mood regulation, physical health, cognitive functioning, and quality of life. There is strong evidence that insomnia, even if it is comorbid with another psychiatric disorder, is treatable with cognitive behavioral therapy. There is a need to develop cognitive behavioral approaches to the other types of sleep disturbance often experienced by patients with psychiatric disorders, such as hypersomnia, reduced sleep need, delayed phase, nocturnal panic attacks, and nightmares. The possibility of developing a transdiagnostic treatment that comprehensively treats sleep disturbance for use across psychiatric disorders is discussed because (a) there are many disorders in which multiple types of sleep disturbance can be characteristic at one time or over the life-course of the disorder and (b) there are considerable challenges inherent to disseminating any new treatments but particularly many "disorder-specific" treatments.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, California 94720-1650, USA.
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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]
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