[Cognitive-behavioral therapy in panic disorder]

Trajectories of behavioral avoidance in real time: Associations with temperament and physiological dysregulation in preschoolers

Although excessive avoidance has been implicated in mental health problems and socioemotional difficulties, relatively little is known about dynamic changes of avoidance behaviors. We used a latent class growth analysis to examine the temporal course of avoidance behaviors in real time and determined whether the derived classes were distinguishable on temperament and physiological markers of regulation and reactivity (N = 153; M_age = 4.20 years). A three-class solution was found and identified a low, medium, and high increasing avoidance group. The high and increasing avoidance group had the highest physiological reactivity (cortisol reactivity) and shyness, and the lowest physiological regulation (i.e., respiratory sinus arrythmia suppression). High and increasing avoidance may therefore be associated with temperamental and physiological indices of risk implicated in maladjustment and highlight the value of data-driven, group-based approaches for examining dynamic patterns of behavior.

Adapting cognitive-behavioral therapy for a Malaysian muslim

Background: Over the years, cognitive-behavioural therapy (CBT) has gained momentum because of its robust evidence in the treatment of several disorders. However, there is an issue of religious and cultural appropriateness as CBT principles are based on Western conceptualization. This single-case study (N = 1) implements a culturally and religiously adapted CBT on a 34-year-old male with panic disorder with agoraphobia in Malaysia. The client had symptoms comprising various episodes of sudden onset of breathlessness, accelerated heart rate, and fear of dying for the last 14 years. The CBT was culturally and religiously adapted based on (1) A CBT manual in Bahasa Malaysia that was previously modified and adjusted according to the norms of the Malaysian society and (2) General guidelines in "Religious-Cultural Psychotherapy in the Management of Anxiety Patients" by Razali et al in 2002. The present modified CBT had 3 assessments formulation sessions and 12 intervention sessions. Methods: The first 6 sessions were based on the behaviour component of CBT (ie, a relaxation technique using Islamic prayer, reciting verses from the Holy Quran, slow breathing exercise, body scan, and progressive muscular relaxation). However, sessions 7 to 12 were focused on cognitive restructuring and exercises, such as identification of negative automatic thoughts, cognitive distortions, dysfunctional thought records, vertical arrow technique, and the coping statement was practised through collaborative empiricism, while implementing Islamic and cultural elements. The focus of termination sessions was on interoceptive exposure, cognitive rehearsal, and in vivo situational exposure. Results: Beck Anxiety Inventory (BAI) was administered at regular intervals. BAI scores revealed the effectiveness of adapting the intervention. Conclusion: Panic attacks, worry about panic attacks, and anxiety scores reduced remarkably and the client was able to go out of the house, travel independently, and pursue religious/social activities.

Analysis of brief Cognitive Behavioral Therapy for panic discorder

The aim of this study was to determine if a modification made to the traditional treatments for panic disorder (PD) proved to be effective in adjusting to the cultural and economic characteristics of patients in the southern Andean Region of Colombia. A quasi-experimental model was used, measurements were taken before and after treatment and follow-ups took place after 1 and 2 years; the sample was made up of 82 people (47 women and 35 men, with an average age of 34 and 29 years respectively). Results showed a reduction of PD clinical symptoms after the treatment (d>0.8), the significance in all cases was p <0.001 and changes maintained throughout the follow up period. In conclusion, it is posible to draw the treatment closer to the socio-cultural characteristics of patients to whom it is directed and the number of sessions could be reduced maintaining the effectiveness of the treatment.

Contribution of Group Therapeutic Factors to the Outcome of Cognitive-Behavioral Therapy for Patients with Panic Disorder

BACKGROUND

Investigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive-behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce.

OBJECTIVES

To identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT.

DESIGN

Non-controlled clinical trial.

METHODS

A 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors.

RESULTS

The sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors.

CONCLUSIONS

Therapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.

"But it might be a heart attack": intolerance of uncertainty and panic disorder symptoms

Panic disorder models describe interactions between feared anxiety-related physical sensations (i.e., anxiety sensitivity; AS) and catastrophic interpretations therein. Intolerance of uncertainty (IU) has been implicated as necessary for catastrophic interpretations in community samples. The current study examined relationships between IU, AS, and panic disorder symptoms in a clinical sample. Participants had a principal diagnosis of panic disorder, with or without agoraphobia (n=132; 66% women). IU was expected to account for significant variance in panic symptoms controlling for AS. AS was expected to mediate the relationship between IU and panic symptoms, whereas IU was expected to moderate the relationship between AS and panic symptoms. Hierarchical linear regressions indicated that IU accounted for significant unique variance in panic symptoms relative to AS, with comparable part correlations. Mediation and moderation models were also tested and suggested direct and indirect effects of IU on panic symptoms through AS; however, an interaction effect was not supported. The current cross-sectional evidence supports a role for IU in panic symptoms, independent of AS.

Anxiety, panic disorder and coronary artery disease: issues concerning physical exercise and cognitive behavioral therapy

Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.