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Mao W, Shalaby R, Owusu E, Elgendy H, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Agyapong VIO. Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge. J Clin Med 2023; 12:7559. [PMID: 38137628 PMCID: PMC10744019 DOI: 10.3390/jcm12247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
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Scholten W, ten Have M, van Geel C, van Balkom A, de Graaf R, Batelaan N. Recurrence of anxiety disorders and its predictors in the general population. Psychol Med 2023; 53:1334-1342. [PMID: 34294172 PMCID: PMC10009370 DOI: 10.1017/s0033291721002877] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/19/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anxiety disorders frequently recur in clinical populations, but the risk of recurrence of anxiety disorders is largely unknown in the general population. In this study, recurrence of anxiety and its predictors were studied in a large cohort of the adult general population. METHODS Baseline, 3-year and 6-year follow-up data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Respondents (N = 468) who had been in remission for at least a year prior to baseline were included. Recurrence was assessed at 3 and 6 years after baseline, using the Composite International Diagnostic Interview version 3.0. Cumulative recurrence rates were estimated using the number of years since remission of the last anxiety disorder. Furthermore, Cox regression analyses were conducted to investigate predictors of recurrence, using a broad range of putative predictors. RESULTS The estimated cumulative recurrence rate was 2.1% at 1 year, 6.6% at 5 years, 10.6% at 10 years, and 16.2% at 20 years. Univariate regression analyses predicted a shorter time to recurrence for several variables, of which younger age at interview, parental psychopathology, neuroticism and a current depressive disorder remained significant in the, age and gender-adjusted, multivariable regression analysis. CONCLUSIONS Recurrence of anxiety disorders in the general population is common and the risk of recurrence extends over a lengthy period of time. In clinical practice, alertness to recurrence, monitoring of symptoms, and quick access to health care in case of recurrence are needed.
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Affiliation(s)
- Willemijn Scholten
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Carmen van Geel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Anton van Balkom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Neeltje Batelaan
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
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Sung SC, Lim L, Lim SH, Finkelstein EA, Chin SLH, Annathurai A, Chakraborty B, Strauman TJ, Pollack MH, Ong MEH. Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety. BMC Psychiatry 2022; 22:795. [PMID: 36527018 PMCID: PMC9756520 DOI: 10.1186/s12888-022-04387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Approximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1-2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms. METHODS This multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore's largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone. DISCUSSION This trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.
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Affiliation(s)
- Sharon C. Sung
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Leslie Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Swee Han Lim
- grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Eric A. Finkelstein
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore
| | - Steven Lim Hoon Chin
- grid.413815.a0000 0004 0469 9373Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
| | - Annitha Annathurai
- grid.508163.90000 0004 7665 4668Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886 Singapore
| | - Bibhas Chakraborty
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.4280.e0000 0001 2180 6431National University of Singapore, 6 Science Drive 2, Singapore, 117546 Singapore ,grid.26009.3d0000 0004 1936 7961Duke University, 2424 Erwin Road, Suite 1102, Durham, NC 27710 USA
| | - Timothy J. Strauman
- grid.189509.c0000000100241216Duke University Medical Center, 10 Duke Medicine Cir, Durham, NC 27710 USA
| | - Mark H. Pollack
- grid.240684.c0000 0001 0705 3621Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, Chicago, IL 60612 USA ,grid.476678.c0000 0004 5913 664XSage Therapeutics, 215 First Street, Cambridge, MA 02142 USA
| | - Marcus Eng Hock Ong
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
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Lu G, Jia R, Liang D, Yu J, Wu Z, Chen C. Effects of music therapy on anxiety: A meta-analysis of randomized controlled trials. Psychiatry Res 2021; 304:114137. [PMID: 34365216 DOI: 10.1016/j.psychres.2021.114137] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/06/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
This study aims to evaluate the efficacy of music therapy on anxiety from randomized controlled trials (RCTs). The following electronic databases were utilized for selecting eligible studies that were published from inception to March 2021: PubMed, Cochrane Library, PsycINFO, Medline, Web of Science, and Embase. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the efficacy of music therapy on anxiety. Thirty-two studies with 1,924 participants were included in the meta-analysis. Music therapy lasted an average of 7.5 sessions (range, 1-24 sessions), while the average follow-up duration was 7.75 weeks (range, 1-16 weeks). Music therapy significantly reduced anxiety compared to the control group at post-intervention (SMD = -0.36, 95% CI: -0.54 to -0.17, p < 0.05), but not at follow-up (SMD = -0.23, 95% CI: -0.53 to 0.08, p >0.05). Subgroup analysis found a significantly positive effect of music therapy on anxiety in < 60 and ≥ 60 age-group (SMD = -0.31, 95% CI: -0.52 to -0.09, p < 0.05; SMD = -0.45, 95% CI: -0.85 to -0. 05, p < 0.05), developed and developing country group (SMD = -0.28, 95% CI: -0.51 to -0.06, p < 0.05; SMD = -0.49, 95% CI: -0.80 to -0.17, p < 0.05), < 12 and ≥ 12 sessions group (SMD = -0.24, 95% CI: = -0.44 to -0.03, p < 0.05; SMD = -0.59, 95% CI: -0.95 to -0.22, p < 0.05), respectively. Our study indicated that music therapy can significantly improve anxiety during treatment. But given that only eight RCTs reported the effects of music therapy at follow-up and the duration of follow-up was inconsistent, further researches are needed on the lasting effects after the intervention is discontinued.
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Affiliation(s)
- Guangli Lu
- Institute of Business, School of Business, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Ruiying Jia
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Dandan Liang
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Jingfen Yu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Zhen Wu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Chaoran Chen
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China.
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Behenck ADS, Wesner AC, Guimaraes LSP, Manfro GG, Dreher CB, Heldt E. Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy. Issues Ment Health Nurs 2021; 42:112-118. [PMID: 32643490 DOI: 10.1080/01612840.2020.1780527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy.
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Affiliation(s)
- Andressa da Silva Behenck
- School of Nursing, Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ana Cristina Wesner
- Federal University of Health Sciences of Porto Alegre (UFCSPA) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Gisele Gus Manfro
- Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Blaya Dreher
- Federal University of Rio Grande do Sul (UFRGS), Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre and Graduation in Medicine of Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Elizeth Heldt
- School of Nursing, Federal University of Rio Grande do Sul (UFRGS) and Anxiety Disorders Program of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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The Effects of the Five-Session Cognitive Behavior Group Therapy for Panic Disorders: Ultra-Brief Treatment. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lorimer B, Kellett S, Nye A, Delgadillo J. Predictors of relapse and recurrence following cognitive behavioural therapy for anxiety-related disorders: a systematic review. Cogn Behav Ther 2020; 50:1-18. [DOI: 10.1080/16506073.2020.1812709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ben Lorimer
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Arthur Nye
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Lorimer B, Delgadillo J, Kellett S, Lawrence J. Dynamic prediction and identification of cases at risk of relapse following completion of low-intensity cognitive behavioural therapy. Psychother Res 2020; 31:19-32. [PMID: 32114926 DOI: 10.1080/10503307.2020.1733127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Low-intensity cognitive behavioural therapy (LiCBT) can help to alleviate acute symptoms of depression and anxiety, but some patients relapse after completing treatment. Little is known regarding relapse risk factors, limiting our ability to predict its occurrence. Therefore, this study aimed to develop a dynamic prediction tool to identify cases at high risk of relapse. Method: Data from a longitudinal cohort study of LiCBT patients was analysed using a machine learning approach (XGBoost). The sample included n = 317 treatment completers who were followed-up monthly for 12 months (n = 223 relapsed; 70%). An ensemble of XGBoost algorithms was developed in order to predict and adjust the estimated risk of relapse (vs maintained remission) in a dynamic way, at four separate time-points over the course of a patient's journey. Results: Indices of predictive accuracy in a cross-validation design indicated adequate generalizability (AUC range = 0.72-0.84; PPV range = 71.2-75.3%; NPV range = 56.0-74.8%). Younger age, unemployment, (non-)linear treatment responses, and residual symptoms were identified as important predictors. Discussion: It is possible to identify cases at risk of relapse and predictive accuracy improves over time as new information is collected. Early identification coupled with targeted relapse prevention could considerably improve the longer-term effectiveness of LiCBT.
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Affiliation(s)
- Ben Lorimer
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Wesner AC, Behenck A, Finkler D, Beria P, Guimarães LSP, Manfro GG, Blaya C, Heldt E. Resilience and coping strategies in cognitive behavioral group therapy for patients with panic disorder. Arch Psychiatr Nurs 2019; 33:428-433. [PMID: 31280790 DOI: 10.1016/j.apnu.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although resilience and coping are important factors associated with mental health, they are rarely investigated in the treatment of patients with panic disorder (PD). OBJECTIVE To evaluate the response to four resilience and coping strategy sessions added to the standard cognitive behavioral group therapy (CBGT) protocol for PD. DESIGN Controlled clinical trial. METHODS The control group (n = 50) attended 12 CBGT sessions, while the intervention group (n = 50) received four additional resilience and coping strategy sessions, i.e., 16 in total. Symptom severity, resilience, coping strategies, and quality of life were assessed at baseline and post-CBGT. RESULTS Symptom severity and maladaptive coping strategies decreased significantly in both groups. However, the intervention group had increased resilience and improvement in the environment domain of quality of life. CONCLUSIONS Additional sessions have potential benefits for coping skills and resilience in PD patients, but these benefits should be evaluated in further long-term studies.
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Affiliation(s)
- Ana Cristina Wesner
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Andressa Behenck
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Débora Finkler
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Pedro Beria
- Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Gisele Gus Manfro
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Carolina Blaya
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil; Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil; Graduate Program in Psychiatry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elizeth Heldt
- Graduate Program in Nursing, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, RS, Brazil.
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Respiratory subtype of panic disorder: Can serum phosphate levels be a possible outcome to group cognitive-behavior therapy? J Affect Disord 2018; 235:474-479. [PMID: 29680728 DOI: 10.1016/j.jad.2018.04.002] [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] [Received: 11/20/2017] [Revised: 02/17/2018] [Accepted: 04/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Panic disorder (PD) respiratory subtype (RS) was described in order to cluster patients according to their symptoms. These patients are characterized by experiencing a relatively high number of noticeable respiratory symptoms during a panic attack (PA) and a higher reactivity to CO2. In this study, we aimed to evaluate the clinical relevance of this diagnostic category, evaluating if there are different responses to cognitive-behavioral therapy in patients with panic disorder RS as compared to those with the non-respiratory subtype (NRS), using serum phosphate as a biological marker. METHODS Patients were assessed by a clinical interview followed by a structured diagnostic interview (M.I.N.I) and classified as RS or NRS based on symptoms. The severity of PD was evaluated throughout the PDSS, CGI, HAM-A, STAI and the BDI rating scales. All patients underwent 12 structured sessions of group-CBT for PD and had their blood collected at baseline and after treatment to assess phosphate levels. RESULTS One hundred and thirty-eight patients have been assessed, and 102 were included in this trial. Sixty-nine patients completed the treatment protocol, 42 were classified as RS and 27 as NRS. Both RS and NRS patients improved in all clinical scales (p < 0.001). The mean phosphate levels increased from 2.44 mg/dl ± 0.49 at baseline to 3.38 mg/dl ± 0.52 (p < 0.01) in the RS group as well as from 2.46 mg/dl ± 0.64 at baseline to 3.46 mg/dl ± 0.61 (p < 0.01) in the NSR group. LIMITATIONS Small sample size and the lack of assessment of other clinical and physiological parameters, such as respiratory variables. CONCLUSION Our findings suggest that both RS and NRS benefit from group CBT and that there was a change in phosphate levels after effective treatment in both groups. Our data support the idea that there is a reversal of the conditions that promote hypophosphatemia as chronic hyperventilation after CBT treatment, whereas it is in disagreement to the presence of two different PD subtypes based on phosphate levels once their rates did not differ at baseline and had a similar increase after effective treatment.
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Caldirola D, Alciati A, Riva A, Perna G. Are there advances in pharmacotherapy for panic disorder? A systematic review of the past five years. Expert Opin Pharmacother 2018; 19:1357-1368. [PMID: 30063164 DOI: 10.1080/14656566.2018.1504921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Several effective medications are available for treating panic disorder (PD). However, outcomes are unsatisfactory in a number of patients, suggesting the usefulness of expanding the array of antipanic drugs and improving the quality of response to current recommended treatments. AREAS COVERED The authors have performed an updated systematic review of pharmacological studies (phase III onwards) to examine whether advances have been made in the last five years. Only four studies were included. D-cycloserine no longer seemed promising as a cognitive-behavioral therapy (CBT) enhancer. Some preliminary findings concerning the optimization of recommended medications deserved consideration, including: the possibility that SSRIs are more effective than CBT alone in treating panic attacks, combined therapy is preferable when agoraphobia is present, and clonazepam is more potent than paroxetine in decreasing panic relapse. EXPERT OPINION Given the lack of novel treatments, expanding a personalized approach to the existing medications seems to be the most feasible strategy to improve pharmacotherapy outcomes regarding PD. Recent technological progress, including wearable devices collecting real-time data, 'big data' platforms, and application of machine learning techniques might help make outcome prediction more reliable. Further research on previously promising novel treatments is also recommended.
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Affiliation(s)
- Daniela Caldirola
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
| | - Alessandra Alciati
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
- b Humanitas Clinical and Research Center , Milan , Italy
| | - Alice Riva
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
| | - Giampaolo Perna
- a Department of Clinical Neurosciences , Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi , Albese con Cassano, Como , Italy
- c Department of Biomedical Sciences , Humanitas University , Rozzano, Milan , Italy
- d Department of Psychiatry and Neuropsychology, Faculty of Health , Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- e Department of Psychiatry and Behavioral Sciences , Leonard Miller School of Medicine, Miami University , Miami , FL , USA
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Abstract
The theme of the Association for Behavioral and Cognitive Therapies (ABCT) 50th Anniversary was to honor the past and envision the future. From the wisdom, foresight, and determination of the pioneers of our organization, and the continuous upholding of the scientific method over the last 50 years, cognitive behavioral therapy (CBT) has become the most empirically supported psychological treatment for a wide array of mental health problems. Yet, we still have a long way to go. This address outlines a vision for the future of CBT, which involves greater collaborative science, with all minds working together on the same problem, and greater attention to the risk factors and critical processes that underlie psychopathology and explain treatment change. Such knowledge generation can inform the development of new, more efficient and more effective therapies that are tailored with more precision to the needs of each person. Latest technologies provide tools for a precision focus while at the same time increasing the reach of our treatments to the many for whom traditional therapies are unavailable. Our impact will be greatly enhanced by large samples with common methods and measures that inform a precision approach. We have come a long way since ABCT was founded in 1966, and we are poised to make even larger strides in our mission to enhance health and well-being by harnessing science, our major guiding principle.
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Abstract
Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic-pituitary-adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90095, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Thalia C Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mohammed R Milad
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Charleston, Massachusetts, USA
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Faculty of Science, Technische Universitaet Dresden, Dresden, Germany
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14
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Abstract
Anxiety disorders (separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, and generalised anxiety disorder) are common and disabling conditions that mostly begin during childhood, adolescence, and early adulthood. They differ from developmentally normative or stress-induced transient anxiety by being marked (ie, out of proportion to the actual threat present) and persistent, and by impairing daily functioning. Most anxiety disorders affect almost twice as many women as men. They often co-occur with major depression, alcohol and other substance-use disorders, and personality disorders. Differential diagnosis from physical conditions-including thyroid, cardiac, and respiratory disorders, and substance intoxication and withdrawal-is imperative. If untreated, anxiety disorders tend to recur chronically. Psychological treatments, particularly cognitive behavioural therapy, and pharmacological treatments, particularly selective serotonin-reuptake inhibitors and serotonin-noradrenaline-reuptake inhibitors, are effective, and their combination could be more effective than is treatment with either individually. More research is needed to increase access to and to develop personalised treatments.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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Finkler DC, Wesner AC, Heldt E. Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico. PSICOLOGIA: TEORIA E PESQUISA 2016. [DOI: 10.1590/0102-3772e322217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O estudo investigou o impacto das características de temperamento e caráter na resposta à terapia cognitivo-comportamental (TCC) para pacientes com transtorno de pânico (TP). Um total de 55 pacientes realizou 12 sessões de TCC em grupo (TCCG). A gravidade dos sintomas foi verificada antes e após a intervenção, e o Inventário de Temperamento e Caráter de Cloninger foi aplicado no início do tratamento. Observou-se uma redução significativa na gravidade do TP após a intervenção. Análises de regressão indicaram que as características de temperamento (persistência) e caráter (autodirecionamento e cooperatividade) não se mostraram significativamente relacionadas à melhora da agorafobia e de sintomas depressivos, permanecendo a gravidade inicial desses sintomas como fatores independentes de resposta à TCCG.
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Liu Y, Sareen J, Bolton J, Wang J. Development and validation of a risk-prediction algorithm for the recurrence of panic disorder. Depress Anxiety 2015; 32:341-8. [PMID: 25774487 DOI: 10.1002/da.22359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To develop and validate a risk prediction algorithm for the recurrence of panic disorder. METHODS Three-year longitudinal data were taken from the National Epidemiologic Survey on Alcohol and Related Conditions (2001/2002-2004/2005). One thousand six hundred and eighty one participants with a lifetime panic disorder and who had not had panic attacks for at least 2 months at baseline were included. The development cohort included 949 participants; 732 from different census regions were in the validation cohort. Recurrence of panic disorder over the follow-up period was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria. Logistic regression was used for deriving the algorithm. Discrimination and calibration were assessed in the development and the validation cohorts. RESULTS The developed algorithm consisted of 11 predictors: age, sex, panic disorder in the past 12 months, nicotine dependence, rapid heartbeat/tachycardia, taking medication for panic attacks, feelings of choking and persistent worry about having another panic attack, two personality traits, and childhood trauma. The algorithm had good discriminative power (C statistic = 0.7863, 95% CI: 0.7487, 0.8240). The C statistic was 0.7283 (95% CI: 0.6889, 0.7764) in the external validation data set. CONCLUSIONS The developed risk algorithm for predicting the recurrence of panic disorder has good discrimination and excellent calibration. Data related to the predictors can be easily attainable in routine clinical practice. It can be used by clinicians to calculate the probability of recurrence of panic disorder in the next 3 years for individual patients, communicate with patients regarding personal risks, and thus improve personalized treatment approaches.
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Affiliation(s)
- Yan Liu
- Faculty of Medicine, Department of Psychiatry, University of Calgary, Calgary, Canada; Faculty of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Booster Sessions after Cognitive-Behavioural Group Therapy for Panic Disorder: Impact on Resilience, Coping, and Quality of Life. Behav Cogn Psychother 2014; 43:513-25. [PMID: 24914489 DOI: 10.1017/s1352465814000289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events. AIMS To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD. METHOD A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively. RESULTS Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations. CONCLUSIONS The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.
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Wesner AC, Gomes JB, Detzel T, Blaya C, Manfro GG, Heldt E. Effect of cognitive-behavioral group therapy for panic disorder in changing coping strategies. Compr Psychiatry 2014; 55:87-92. [PMID: 23958283 DOI: 10.1016/j.comppsych.2013.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 05/23/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Cognitive-behavioral group therapy (CBGT) is an efficient treatment for panic disorder (PD). However, the role of CBGT in enhancing strategies to cope with stressful events has not been established. AIM To evaluate the effect of CBGT on the choice of coping strategy by PD patients compared to a group of individuals without mental disorders. METHODS Forty-eight PD patients who completed a 12-session CBGT protocol were compared to 75 individuals without mental disorders regarding coping strategies as evaluated by the Coping Strategies Inventory (CSI). The severity of PD was assessed at baseline and after CBGT through the Clinical Global Impression (CGI) scale, the Hamilton Anxiety Scale (HAM-A), and the Panic Inventory (PI). RESULTS Treatment was effective in reducing PD severity in all outcome measures. Patients used significantly fewer confrontation, escape and avoidance strategies after CBGT. The use of more adaptive coping strategies was related to a decrease in panic attacks and anticipatory anxiety. Application of the CSI showed that the use of strategies was also significantly different in patients as compared to the control group, except for escape and avoidance, which became similar after the CBGT protocol. CONCLUSIONS Despite the changes observed after the CBGT protocol, the choice of coping strategy was still different in patients vs. controls. The current CBGT protocol was used specifically to assess PD symptoms. Other cognitive tools should be included to address maladaptive coping strategies.
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Affiliation(s)
- Ana Cristina Wesner
- Anxiety Disorders Program, Hospital de Clínicas de Porto Alegre, Brazil; Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Recurrence of anxiety disorders and its predictors. J Affect Disord 2013; 147:180-5. [PMID: 23218248 DOI: 10.1016/j.jad.2012.10.031] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 10/24/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The chronic course of anxiety disorders and its high burden of disease are partly due to the recurrence of anxiety disorders after remission. However, knowledge about recurrence rates and predictors of recurrence is scarce. This article reports on recurrence rates of anxiety disorders and investigates predictors of recurrence from a broad range of socio-demographic characteristics, illness-related and psychosocial putative predictors. METHODS Baseline and 2-year follow-up data were derived from the Netherlands Study of Depression and Anxiety (NESDA). Participants who had at least one lifetime anxiety disorder (panic disorder with or without agoraphobia, agoraphobia alone, social phobia or generalized anxiety disorder), but were remitted at baseline (N=429) were included. Recurrence of anxiety disorders during the 2-year follow-up period was assessed using the Composite International Diagnostic Interview, version 2.1. RESULTS Recurrence rates among pure and multiple anxiety disorders did not differ significantly and the overall recurrence rate of anxiety disorders was 23.5%. In those recurring, the incidence of a new anxiety disorder was common (32.7%). Disability and anxiety sensitivity remained predictive of recurrence of anxiety disorders in multivariable regression analysis. LIMITATIONS The included participants had more severe symptoms at baseline than the non-response group and lifetime anxiety diagnoses were assessed, retrospectively. CONCLUSIONS Recurrence of anxiety disorders is common and clinicians should be aware of the diagnostic instability within anxiety disorders. Disability and anxiety sensitivity are independent predictors of recurrence of anxiety disorders. Altering these predictors in regular cognitive behavioural therapy could contribute to the reduction of recurrence.
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Cognitive-behavioral group therapy for youths with anxiety disorders in the community: effectiveness in low and middle income countries. Behav Cogn Psychother 2013; 41:255-64. [PMID: 23438373 DOI: 10.1017/s1352465813000015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). AIMS To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. METHOD A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a cross-sectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, self- and parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). RESULTS Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. CONCLUSIONS Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.
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White KS, Payne LA, Gorman JM, Shear MK, Woods SW, Saksa JR, Barlow DH. Does maintenance CBT contribute to long-term treatment response of panic disorder with or without agoraphobia? A randomized controlled clinical trial. J Consult Clin Psychol 2012; 81:47-57. [PMID: 23127290 DOI: 10.1037/a0030666] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the possibility that maintenance cognitive behavior therapy (M-CBT) may improve the likelihood of sustained improvement and reduced relapse in a multi-site randomized controlled clinical trial of patients who met criteria for panic disorder with or without agoraphobia. METHOD Participants were all patients (N = 379) who first began an open trial of acute-phase CBT. Patients completing and responding to acute-phase treatment were randomized to receive either 9 monthly sessions of M-CBT (n = 79) or assessment only (n = 78) and were then followed for an additional 12 months without treatment. RESULTS M-CBT produced significantly lower relapse rates (5.2%) and reduced work and social impairment compared to the assessment only condition (18.4%) at a 21-month follow-up. Multivariate Cox proportional hazards models showed that residual symptoms of agoraphobia at the end of acute-phase treatment were independently predictive of time to relapse during 21-month follow-up (hazards ratio = 1.15, p < .01). CONCLUSIONS M-CBT aimed at reinforcing acute treatment gains to prevent relapse and offset disorder recurrence may improve long-term outcome for panic disorder with and without agoraphobia.
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Affiliation(s)
- Kamila S White
- Department of Psychology, University of Missouri, St. Louis, MO 63121, USA.
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