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Noda S, Shirotsuki K, Nakao M. Low-intensity mindfulness and cognitive-behavioral therapy for social anxiety: a pilot randomized controlled trial. BMC Psychiatry 2024; 24:190. [PMID: 38454396 PMCID: PMC10921717 DOI: 10.1186/s12888-024-05651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive-behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. METHODS Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. RESULTS A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51-1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. CONCLUSIONS These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.
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Affiliation(s)
- Shota Noda
- Department of Psychology, Translational Clinical Psychology, Philipps University Marburg, Schulstraße 12, Marburg, 35032, Germany.
- Research Institute of Cognitive Behavior Therapy, Musashino University, 3-3-3 Ariake, Koutou-Ku, Tokyo, 135-8181, Japan.
| | - Kentaro Shirotsuki
- Faculty of Human Sciences, Musashino University, 3-3-3 Ariake, Koutou-Ku, Tokyo, 135-8181, Japan
| | - Mutsuhiro Nakao
- Department of Psychosomatic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita-Shi, Chiba, 286-8686, Japan
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McEvoy PM, Johnson AR, Kazantzis N, Egan SJ. Predictors of homework engagement in group CBT for social anxiety: client beliefs about homework, its consequences, group cohesion, and working alliance. Psychother Res 2024; 34:68-80. [PMID: 38109521 DOI: 10.1080/10503307.2023.2286993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) is effective, but little data exist on generic relational components of the therapeutic process, such as group cohesion and therapy alliance, and central CBT-specific components such as homework engagement, beliefs, and perceived consequences. The aim of this study was to investigate the relationships between homework, group cohesion, and working alliance during group CBT for social anxiety disorder. METHOD Participants (N = 105) with SAD engaged in 12 sessions of group CBT. Measures of homework, working alliance, and group cohesion were completed at multiple points throughout treatment. Random-intercept cross-lagged panel models were used to evaluate the prospective relationships between measures. RESULTS Prospective relationships between the homework outcomes did not vary throughout the treatment period, with the only significant relationships seen between the random intercepts ("trait" levels). Homework beliefs were a significant negative predictor of future group cohesion, but only in mid- to late-treatment. Homework consequences and working alliance were significantly and positively predictive of each other throughout therapy. CONCLUSION Early homework engagement is associated with higher engagement throughout therapy. Working alliance and homework engagement are important to bolster early in group CBT.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000579493..
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Affiliation(s)
- Peter M McEvoy
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- North Metropolitan Health Service, Centre for Clinical Interventions, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Department of Computer Science, Aalto University, Helsinki, Finland
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | - Sarah J Egan
- Faculty of Health Sciences, Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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Veit L, Jungmann SM, Freitag CM. The Course of Anxiety-Specific Cognitive Bias Following Daycare/Inpatient Treatment in Youths with Social Phobia and School Absenteeism. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:1-10. [PMID: 37768010 DOI: 10.1024/1422-4917/a000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Social phobia (SP) is a common mental disorder in youth often accompanied by absence from school, which may require daycare or inpatient intervention (DC/IN). Objective: The present explorative study investigates changes in anxiety-specific implicit assumptions and interpretation bias following DC/IN. Methods: The study included 16 youths with SP (M age = 15.8 [SD = 1.24], females: 62.5 %) participating in DC/IN. We assessed the main outcomes using the Implicit Association Test and Affective Misattribution Procedure. Results: A large effect was shown for reducing implicit assumptions of feeling anxious (p = .142; η2p = .171) and for reducing the implicit interpretation bias (p = .137; η2p = .162). No change was indicated by effect size in implicit assumptions of feeling socially rejected (p = .649; η2p = .016). Social phobia symptoms initially correlated with changes in implicit assumptions of feeling anxious (r = .45). Conclusion: Effect sizes indicate that implicit anxiety-specific assumptions and interpretation bias descriptively improved following DC/IN. Thus, DC/IN may lead to meaningful improvements of anxiety-specific cognition in some individuals with high SP symptoms, emphasizing the relevance of cognitive behavioral approaches in the treatment of SP. Several limitations are discussed.
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Affiliation(s)
- Lisa Veit
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stefanie Maria Jungmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Germany
| | - Christine Margarete Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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McEvoy PM, Bendlin M, Johnson AR, Kazantzis N, Campbell BNC, Bank SR, Egan SJ. The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder. Psychother Res 2024; 34:54-67. [PMID: 36630684 DOI: 10.1080/10503307.2022.2161966] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.
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Affiliation(s)
- Peter M McEvoy
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
| | - Martyna Bendlin
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Andrew R Johnson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behaviour Therapy and Research, Philadelphia, PA, USA
| | | | | | - Sarah J Egan
- Curtin enAble Institute, Curtin University, Perth, Australia
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
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Kurita K, Obata T, Sutoh C, Matsuzawa D, Yoshinaga N, Kershaw J, Chhatkuli RB, Ota J, Shimizu E, Hirano Y. Individual cognitive therapy reduces frontal-thalamic resting-state functional connectivity in social anxiety disorder. Front Psychiatry 2023; 14:1233564. [PMID: 38179253 PMCID: PMC10764569 DOI: 10.3389/fpsyt.2023.1233564] [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: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Previous neuroimaging studies in social anxiety disorders (SAD) have reported potential neural predictors of cognitive behavioral therapy (CBT)-related brain changes. However, several meta-analyses have demonstrated that cognitive therapy (CT) was superior to traditional exposure-based CBT for SAD. Objective To explore resting-state functional connectivity (rsFC) to evaluate the response to individual CT for SAD patients. Methods Twenty SAD patients who attended 16-week individual CT were scanned pre- and post-therapy along with twenty healthy controls (HCs). The severity of social anxiety was assessed with the Liebowitz Social Anxiety Scale (LSAS). Multi-voxel pattern analysis (MVPA) was performed on the pre-CT data to extract regions associated with a change in LSAS (∆LSAS). Group comparisons of the seed-based rsFC analysis were performed between the HCs and pre-CT patients and between the pre-and post-CT patients. Results MVPA-based regression analysis revealed that rsFC between the left thalamus and the frontal pole/inferior frontal gyrus was significantly correlated with ∆LSAS (adjusted R2 = 0.65; p = 0.00002). Compared with HCs, the pre-CT patients had higher rsFCs between the thalamus and temporal pole and between the thalamus and superior/middle temporal gyrus/planum temporale (p < 0.05). The rsFC between the thalamus and the frontal pole decreased post-CT (p < 0.05). Conclusion SAD patients had significant rsFC between the thalamus and temporal pole, superior/middle temporal gyrus, and planum temporale, which may be indicators of extreme anxiety in social situations. In addition, rsFC between the thalamus and the frontal pole may be a neuromarker for the effectiveness of individual CT.
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Affiliation(s)
- Kohei Kurita
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
| | - Takayuki Obata
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Chihiro Sutoh
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Matsuzawa
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Naoki Yoshinaga
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Jeff Kershaw
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Ritu Bhusal Chhatkuli
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Junko Ota
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Kyriacou T, Hodges J, Gould RL. Predictors and moderators of treatment outcome in late-life anxiety: A systematic review. J Affect Disord 2023; 339:454-470. [PMID: 37442444 DOI: 10.1016/j.jad.2023.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The aim of this review was to identify and critically appraise predictors and moderators of outcomes of psychological and pharmacological treatments for late-life anxiety disorders. Their identification may guide the development of personalised treatments for older people with anxiety disorders. METHODS Web of Science, PsychINFO, CINAHL, Embase, and Pubmed were searched for studies published up to 12 May 2022. Randomised controlled trials and observational studies reporting treatment predictors and moderators were included. Participants with a diagnosis of any anxiety disorder who were aged over 60 years were included. Treatment outcomes included response, remission, and change in anxiety score. RESULTS Thirteen studies met the inclusion criteria. Twenty-three out of 49 predictors or moderators assessed at post-treatment, and 14 out of 33 predictors or moderators assessed at follow-up were statistically significant. Only one predictor, baseline worry severity at post-treatment, was reported in at least three studies. Most studies were rated as having a low risk of bias in at least three areas and satisfied important quality criteria for predictor and moderator analyses. LIMITATIONS Samples were predominantly white, female and highly educated, and most studies were secondary analyses. CONCLUSIONS There is evidence that baseline worry severity appears to predict treatment outcome in late-life anxiety disorders. However, this was only explored in psychological intervention studies and therefore its predictive ability in pharmacotherapy remains unknown. Future research should explore predictors and moderators in a range of anxiety disorders and design methodologically-strong and adequately-powered studies with the primary aim of assessing predictors of treatment outcomes.
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Affiliation(s)
| | - Jade Hodges
- Division of Psychiatry, University College London, London, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
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Franken K, ten Klooster P, Bohlmeijer E, Westerhof G, Kraiss J. Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach. Front Psychiatry 2023; 14:1236551. [PMID: 37817829 PMCID: PMC10560743 DOI: 10.3389/fpsyt.2023.1236551] [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: 06/11/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. Methods In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. Results ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Conclusion Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
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Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
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Rosellini AJ, Andrea AM, Galiano CS, Hwang I, Brown TA, Luedtke A, Kessler RC. Developing Transdiagnostic Internalizing Disorder Prognostic Indices for Outpatient Cognitive Behavioral Therapy. Behav Ther 2023; 54:461-475. [PMID: 37088504 PMCID: PMC10126479 DOI: 10.1016/j.beth.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
A growing literature is devoted to understanding and predicting heterogeneity in response to cognitive behavioral therapy (CBT), including using supervised machine learning to develop prognostic models that could be used to inform treatment planning. The current study developed CBT prognostic models using data from a broad dimensionally oriented pretreatment assessment (324 predictors) of 1,210 outpatients with internalizing psychopathology. Super learning was implemented to develop prognostic indices for three outcomes assessed at 12-month follow-up: principal diagnosis improvement (attained by 65.8% of patients), principal diagnosis remission (56.8%), and transdiagnostic full remission (14.3%). The models for principal diagnosis remission and transdiagnostic remission performed best (AUROCs = 0.71-0.73). Calibration was modest for all three models. Three-quarters (77.3%) of patients in the top tertile of the predicted probability distribution achieved principal diagnosis remission, compared to 35.0% in the bottom tertile. One-third (35.3%) of patients in the top two deciles of predicted probabilities for transdiagnostic complete remission achieved this outcome, compared to 2.7% in the bottom tertile. Key predictors included principal diagnosis severity, social anxiety diagnosis/severity, hopelessness, temperament, and global impairment. While additional work is needed to improve performance, integration of CBT prognostic models ultimately could lead to more effective and efficient treatment of patients with internalizing psychopathology.
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Caldiroli A, Capuzzi E, Tagliabue I, Ledda L, Clerici M, Buoli M. New frontiers in the pharmacological treatment of social anxiety disorder in adults: an up-to-date comprehensive overview. Expert Opin Pharmacother 2023; 24:207-219. [PMID: 36519357 DOI: 10.1080/14656566.2022.2159373] [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: 12/23/2022]
Abstract
INTRODUCTION Social anxiety disorder (SAD) is associated with scarce functioning and poor quality of life. Although selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are currently first-line treatments, side effects are common and affect treatment compliance in approximately 50% of patients. This review aimed to summarize data on the efficacy of unlabeled molecules for SAD treatment. AREAS COVERED Research in the main psychiatric databases was conducted (PubMed, PsychINFO, and EMBASE-Ovid) to select studies investigating the efficacy of marketed molecules not labeled for SAD treatment. EXPERT OPINION Pregabalin at high doses (450-600 mg/day) appears to be a reliable alternative strategy for SAD treatment. Among the SSRIs not labeled for SAD, citalopram showed the most promising results. Quetiapine, levetiracetam, and other antidepressants/serotonergic agents, such as fluoxetine, duloxetine, monoamine oxidase inhibitors, tricyclics, mirtazapine, atomoxetine, nefazodone, vilazodone, and buspirone, presented negative, limited, or contrasting results. Data on anticonvulsants, olanzapine, tiagabine, and ketamine were positive, but preliminary. The risk/benefit ratio must be considered in the prescription of unlabeled compounds; treatment with pregabalin may be associated with somnolence and dizziness. Future research may contribute to the identification of targeted molecules for the treatment of this disorder.
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Affiliation(s)
- Alice Caldiroli
- Department of Mental Health and Addiction, ASST Monza, Monza, Italy
| | - Enrico Capuzzi
- Department of Mental Health and Addiction, ASST Monza, Monza, Italy
| | - Ilaria Tagliabue
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Luisa Ledda
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- Department of Mental Health and Addiction, ASST Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimiliano Buoli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Vagos P, Figueiredo DV, Ganho-Ávila A, Mayr A, Rijo D. Remotely delivered cognitive therapy for social anxiety disorder in adolescence: Preliminary efficacy evidence based on changes throughout treatment. Front Psychol 2023; 13:915677. [PMID: 36755977 PMCID: PMC9901541 DOI: 10.3389/fpsyg.2022.915677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Cognitive therapy has been established as the frontline treatment for adults with social anxiety disorder (SAD); its efficacy with socially anxious adolescents is incipient but promising. This work investigated change in social anxiety symptoms reported by adolescents and their therapist as they go through remotely delivered 10-session cognitive therapy (i.e., CT@TeenSAD). Participants were 21 adolescents (81% females; M age = 16.10) diagnosed with SAD. They reported on change on their social anxiety symptoms at the beginning of each session; their therapist reported on how their symptoms had improved at the end of each session. Results, though preliminary, show that sessions had a significant impact on self- and therapist reported change, with consistent and continuous improvement across intervention sessions. Gender did not impact on that change, but therapist did: though the same pattern of change emerged for both therapists, it was more evident for the therapist with the greatest previous clinical experience. Overall, current findings align with the cognitive therapy framework of progressive gains throughout therapy. They also add evidence on the applicability and usefulness of an online cognitive approach to adolescents diagnosed with SAD.
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Affiliation(s)
- Paula Vagos
- Instituto de Desenvolvimento Humano Portucalense, Universidade Portucalense Infante D. Henrique, Porto, Portugal,Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal,*Correspondence: Paula Vagos,
| | - Diana Vieira Figueiredo
- Instituto de Desenvolvimento Humano Portucalense, Universidade Portucalense Infante D. Henrique, Porto, Portugal
| | - Ana Ganho-Ávila
- Instituto de Desenvolvimento Humano Portucalense, Universidade Portucalense Infante D. Henrique, Porto, Portugal
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Rijo
- Instituto de Desenvolvimento Humano Portucalense, Universidade Portucalense Infante D. Henrique, Porto, Portugal
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What the future holds: Machine learning to predict successful psychotherapy. Behav Res Ther 2022; 156:104116. [DOI: 10.1016/j.brat.2022.104116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022]
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A follow-up study on treatment effects of cognitive-behavioral therapy on social anxiety disorder: Impact of COVID-19 fear during post-lockdown period. Psychiatry Res 2022; 310:114439. [PMID: 35180611 PMCID: PMC8840826 DOI: 10.1016/j.psychres.2022.114439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 12/02/2022]
Abstract
There is a paucity of research on the role of COVID-19 related fear and lockdown on social anxiety disorder (SAD). In a follow-up study during post-lockdown period, we compared social anxiety of individuals with SAD who received cognitive-behavioral therapy (CBT) versus psychoeducational-supportive therapy (PST) before the COVID-19 pandemic, and the impact of COVID-19 related fear. Social anxiety severity was rated by the Social Phobia Inventory (SPIN) at pre-intervention, post-intervention, and post-lockdown periods. Fear of COVID-19 was assessed during the post-lockdown period. The treatment effects in the CBT group (n = 33) were significantly better than the PST group (n = 32) at post-intervention; this was maintained at 14-months following intervention despite COVID-related lockdown. In the PST group, there was no change following the intervention; and the social phobia increased after lockdown. The CBT group had significantly less COVID-19 related fear than the PST group. Social anxiety was positively correlated with fear of COVID-19; and individuals with comorbidities had significantly more fear. Using the hierarchical multiple regression, SPIN post-intervention, COVID-19 fear, and duration of SAD predicted social anxiety severity during the post-lockdown period. In conclusion, the effect of CBT for SAD was maintained through lockdown and was associated with significantly less COVID-19 related fear.
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Abasi I, Pourshahbaz A, Mohammadkhani P, Dolatshahi B, Moradveisi L, Mennin DS. Emotion regulation therapy for social anxiety disorder: a single case series study. Behav Cogn Psychother 2021; 49:1-15. [PMID: 33952371 DOI: 10.1017/s1352465821000175] [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: 11/07/2022]
Abstract
BACKGROUND Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. AIMS It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. METHOD Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. RESULTS SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. CONCLUSION These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.
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Affiliation(s)
- Imaneh Abasi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Current Affiliation: Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Pourshahbaz
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrouz Dolatshahi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Latif Moradveisi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Douglas S Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, United States of America
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Niles AN, Axelsson E, Andersson E, Hedman-Lagerlöf E, Carlbring P, Andersson G, Johansson R, Widén S, Driessen J, Santoft F, Ljótsson B. Internet-based cognitive behavior therapy for depression, social anxiety disorder, and panic disorder: Effectiveness and predictors of response in a teaching clinic. Behav Res Ther 2021; 136:103767. [DOI: 10.1016/j.brat.2020.103767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
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15
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Shahar B. New Developments in Emotion-Focused Therapy for Social Anxiety Disorder. J Clin Med 2020; 9:E2918. [PMID: 32927706 PMCID: PMC7565910 DOI: 10.3390/jcm9092918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.
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Affiliation(s)
- Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem 91905, Israel
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16
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Frick A, Engman J, Alaie I, Björkstrand J, Gingnell M, Larsson EM, Eriksson E, Wahlstedt K, Fredrikson M, Furmark T. Neuroimaging, genetic, clinical, and demographic predictors of treatment response in patients with social anxiety disorder. J Affect Disord 2020; 261:230-237. [PMID: 31655378 DOI: 10.1016/j.jad.2019.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/30/2019] [Accepted: 10/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Correct prediction of treatment response is a central goal of precision psychiatry. Here, we tested the predictive accuracy of a variety of pre-treatment patient characteristics, including clinical, demographic, molecular genetic, and neuroimaging markers, for treatment response in patients with social anxiety disorder (SAD). METHODS Forty-seven SAD patients (mean±SD age 33.9 ± 9.4 years, 24 women) were randomized and commenced 9 weeks' Internet-delivered cognitive behavior therapy (CBT) combined either with the selective serotonin reuptake inhibitor (SSRI) escitalopram (20 mg daily [10 mg first week], SSRI+CBT, n = 24) or placebo (placebo+CBT, n = 23). Treatment responders were defined from the Clinical Global Impression-Improvement scale (CGI-I ≤ 2). Before treatment, patients underwent functional magnetic resonance imaging and the Multi-Source Interference Task taxing cognitive interference. Support vector machines (SVMs) were trained to separate responders from nonresponders based on pre-treatment neural reactivity in the dorsal anterior cingulate cortex (dACC), amygdala, and occipital cortex, as well as molecular genetic, demographic, and clinical data. SVM models were tested using leave-one-subject-out cross-validation. RESULTS The best model separated treatment responders (n = 24) from nonresponders based on pre-treatment dACC reactivity (83% accuracy, P = 0.001). Responders had greater pre-treatment dACC reactivity than nonresponders especially in the SSRI+CBT group. No other variable was associated with clinical response or added predictive accuracy to the dACC SVM model. LIMITATIONS Small sample size, especially for genetic analyses. No replication or validation samples were available. CONCLUSIONS The findings demonstrate that treatment outcome predictions based on neural cingulate activity, at the individual level, outperform genetic, demographic, and clinical variables for medication-assisted Internet-delivered CBT, supporting the use of neuroimaging in precision psychiatry.
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Affiliation(s)
- Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Uppsala University, Uppsala, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Jonas Engman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Iman Alaie
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johannes Björkstrand
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Psychology, Lund University, Lund, Sweden
| | - Malin Gingnell
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Elias Eriksson
- Department of Pharmacology, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kurt Wahlstedt
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Bryde Christensen A, Svart N, Bokelund H, Reinholt N, Eskildsen A, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. Therapists' Perceptions of Individual Patient Characteristics that May Be Hindering to Group CBT for Anxiety and Depression. Psychiatry 2020; 83:344-357. [PMID: 33064967 DOI: 10.1080/00332747.2020.1800292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists' perceptions of within-patient attributes that may be hindering in group CBT in a mental health setting. Method: We explored the perception of individual patient characteristics and related obstacles in 12 psychotherapists in Danish Mental Health Services through semi-structured interviews. The interviews were analyzed using a descriptive qualitative framework. Results: The results revealed four distinct themes that the therapists pointed to as important for the outcome of a 14-week group CBT intervention for social phobia, panic disorder, agoraphobia and major depressive disorder. The four themes were Complexity & severity, External circumstances, Attitudes & coping and Cognitive ability & reflection level. The therapists explained how they perceived higher complexity and severity in the patients as an obstacle, they highlighted that a calm and stable outside environment aided therapeutic change, whilst stressors were hindering. They perceived active coping mechanisms, positive attitudes and high readiness to change as positive factors, whilst dependent and hostile coping mechanisms and negative attitudes were seen as obstacles. Finally, the therapists pointed to cognitive abilities and reflection level, explaining how it could be difficult to obtain good outcomes for patients who's cognitive abilities were debilitated due to psychopathological factors or for patients with a generally low reflection level. Conclusions: The results indicated that the therapists experience group CBT as an intervention that requires certain prerequisites of the patients, and that the four themes should be considered when deciding on treatment options for any given patient. The clinical utility and theoretical implications of the results are discussed.
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18
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Predicting cognitive behavioral therapy outcome in the outpatient sector based on clinical routine data: A machine learning approach. Behav Res Ther 2020; 124:103530. [DOI: 10.1016/j.brat.2019.103530] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/14/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
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19
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Oser M, Khan A, Kolodziej M, Gruner G, Barsky AJ, Epstein L. Mindfulness and Interoceptive Exposure Therapy for Anxiety Sensitivity in Atrial Fibrillation: A Pilot Study. Behav Modif 2019; 45:462-479. [PMID: 31550903 DOI: 10.1177/0145445519877619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia and symptoms overlap with physiological sensations of anxiety. Patients with atrial fibrillation can demonstrate anxiety sensitivity even in the absence of actual atrial fibrillation symptoms. Interoceptive exposure is effective in treating anxiety sensitivity, and recently, mindfulness has been proposed as an enhancement strategy to facilitating inhibitory learning in exposure therapy. This pragmatic study piloted a brief mindfulness and interoceptive exposure treatment for anxiety sensitivity in atrial fibrillation. Eight participants with atrial fibrillation and elevated anxiety sensitivity from a hospital cardiology department participated in the treatment. Anxiety sensitivity significantly decreased during the course of the intervention. These initial findings show proof of concept for this brief intervention in a cardiac-specific behavioral medicine setting.
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Affiliation(s)
- Megan Oser
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Meghan Kolodziej
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gabriel Gruner
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Arthur J Barsky
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Laurence Epstein
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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20
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Tiemens B, Kloos M, Spijker J, Ingenhoven T, Kampman M, Hendriks GJ. Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course; a naturalistic cohort study. BMC Psychiatry 2019; 19:228. [PMID: 31340791 PMCID: PMC6657162 DOI: 10.1186/s12888-019-2214-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND An adequate frequency of treatment might be a prerequisite for a favorable outcome. Unfortunately, there is a diversity of factors that interfere with an adequate frequency of sessions. This occurs especially in the first phase of treatment, while the first phase seems vital for the rest of treatment. The aim of this naturalistic study was to explore the impact of the initial frequency of treatment sessions on treatment outcome in a diverse mental health care population. METHODS Anonymized data were analyzed from 2,634 patients allocated for anxiety disorders, depressive disorders, and personality disorders to outpatient treatment programs in a large general mental health care facility. Patients' treatment outcome was routinely monitored with the Outcome Questionnaire-45 (OQ-45.2), every 12 weeks. Frequency of sessions was assessed for the first three months of treatment. Using Cox-proportional-hazard models, we explored the associations between initial frequency and improvement (reliable significant change) and recovery (reliable and clinically significant change). RESULTS Improvement and recovery were associated with symptom severity and functional impairment at start of treatment, the year the treatment started, number of measurements, the treatment program (anxiety disorders, depressive disorders, and personality disorders) and receiving group therapy other than psychotherapy. In all diagnostic groups, both improvement and recovery were associated with a higher frequency of sessions during the first three months of treatment. For improvement, this effect diminished after three years in treatment; however, for recovery this association was sustained. CONCLUSIONS In addition to severity at start of treatment and other predictors of outcome, a low frequency of initial treatment sessions might lead to a less favorable outcome and a more chronic course of the mental disorder. This association seems not to be limited to a specific diagnostic group, but was found in a large group of patients with common mental disorders (depression and anxiety disorders) and patients with a personality disorder. Despite organizational obstacles, more effort should be made to start treatment quickly by an effective frequency of session.
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Affiliation(s)
- Bea Tiemens
- Pro Persona Research, Renkum, The Netherlands. .,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Margot Kloos
- 0000 0004 0466 1666grid.491369.0Pro Persona Research, Renkum, The Netherlands
| | - Jan Spijker
- 0000 0004 0466 1666grid.491369.0Pro Persona Research, Renkum, The Netherlands ,0000000122931605grid.5590.9Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Theo Ingenhoven
- Personality disorder Expert Centre, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Mirjam Kampman
- 0000 0004 0466 1666grid.491369.0Pro Persona Research, Renkum, The Netherlands ,0000000122931605grid.5590.9Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Mental Health Care, Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- 0000 0004 0466 1666grid.491369.0Pro Persona Research, Renkum, The Netherlands ,0000000122931605grid.5590.9Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands ,Overwaal Centre of Expertise for Anxiety Disorders, OCD and PTSD, Pro Persona Mental Health Care, Nijmegen, The Netherlands ,0000 0004 0444 9382grid.10417.33Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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21
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A meta-analytic review of personality traits and their associations with mental health treatment outcomes. Clin Psychol Rev 2019; 70:51-63. [DOI: 10.1016/j.cpr.2019.04.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022]
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22
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Abbing A, Baars EW, de Sonneville L, Ponstein AS, Swaab H. The Effectiveness of Art Therapy for Anxiety in Adult Women: A Randomized Controlled Trial. Front Psychol 2019; 10:1203. [PMID: 31191400 PMCID: PMC6549595 DOI: 10.3389/fpsyg.2019.01203] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/07/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Art therapy (AT) as a treatment option for anxiety is regularly employed in clinical practice, but scientific evidence for its effectiveness is lacking, since this intervention has hardly been studied. The aim was to study the effectiveness of AT on anxiety in adult women. The specific type of AT studied was anthroposophic AT. METHODS A RCT comparing AT versus a waiting list (WL) condition on anxiety symptom severity, quality of life, and emotion regulation. Factors influencing treatment outcome were additionally explored. Participants were women, aged 18-65 years, diagnosed with generalized anxiety disorder, social anxiety disorder or panic disorder, with moderate to severe anxiety symptoms. The trial was registered in the Dutch Trial Registration (NTR28143). RESULTS Fifty-nine women were included, of which 47 completed the trial. Both per-protocol and intention-to treat analyses demonstrated effectiveness of AT compared to WL, showing a reduction in anxiety, an increase in subjective quality of life (both with large effects) and an improvement in accessibility of emotion regulation strategies (medium effect). Treatment effects remained after 3 months follow-up. Improved acceptance of emotions and improved goal-oriented action are aspects of emotion regulation that are associated with the decrease in anxiety level. CONCLUSION AT is effective in reducing anxiety symptoms, improving quality of life and aspects of emotion regulation. Future RCTs should use active controls (treatment as usual) and study cost-effectiveness.
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Affiliation(s)
- Annemarie Abbing
- Faculty of Health, University of Applied Sciences Leiden, Leiden, Netherlands
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - Erik W. Baars
- Faculty of Health, University of Applied Sciences Leiden, Leiden, Netherlands
| | - Leo de Sonneville
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Anne S. Ponstein
- Faculty of Health, University of Applied Sciences Leiden, Leiden, Netherlands
| | - Hanna Swaab
- Clinical Neurodevelopmental Sciences, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
- Leiden Institute of Brain and Cognition, Leiden, Netherlands
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23
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Asher M, Hermesh H, Gur S, Marom S, Aderka I. Do men and women arrive, stay, and respond differently to cognitive behavior group therapy for social anxiety disorder? J Anxiety Disord 2019; 64:64-70. [PMID: 31048094 DOI: 10.1016/j.janxdis.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/06/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maya Asher
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Haggai Hermesh
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Shay Gur
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Sofi Marom
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Idan Aderka
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel.
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24
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2018. [DOI: 10.1177/0004867418799453] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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25
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McLellan LF, Stapinski LA, Peters L. Pre-treatment CBT-Mindedness Predicts CBT Outcome. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9977-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Cohen JN, Drabick DAG, Blanco C, Schneier FR, Liebowitz MR, Heimberg RG. Pharmacotherapy for social anxiety disorder: Interpersonal predictors of outcome and the mediating role of the working alliance. J Anxiety Disord 2017; 52:79-87. [PMID: 29102818 PMCID: PMC5689479 DOI: 10.1016/j.janxdis.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022]
Abstract
Social anxiety disorder (SAD) is highly prevalent and associated with high levels of impairment and distress. Therapies for SAD leave many patients symptomatic at the end of treatment, and little is known about predictors or mechanisms of treatment outcome. Given the interpersonal dysfunction fundamental to SAD, this study investigated whether prominent interpersonal features of SAD (submissive behavior, childhood maltreatment, suppression of anger, and depression) predicted attrition and response to pharmacotherapy and whether the working alliance mediated these relationships. This is the first study to examine the role of the working alliance in pharmacotherapy for SAD. One hundred thirty-eight treatment-seeking individuals with a primary diagnosis of SAD received 12 weeks of open treatment with paroxetine. Higher levels of depression predicted greater severity of SAD at the end of treatment, and higher levels of submissive behavior and childhood emotional maltreatment predicted a greater probability of attrition from treatment. The psychiatrist-assessed working alliance mediated response to pharmacotherapy for individuals who reported a history of emotional maltreatment. These results identify variables that predict pharmacotherapy outcome and emphasize the importance of the working alliance as a mechanism of treatment response for those with a history of emotional maltreatment. Implications for person-specific treatment selection are discussed.
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Affiliation(s)
- Jonah N Cohen
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA
| | - Deborah A G Drabick
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA
| | - Carlos Blanco
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Franklin R Schneier
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael R Liebowitz
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA
| | - Richard G Heimberg
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA.
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27
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Emotion regulation related neural predictors of cognitive behavioral therapy response in social anxiety disorder. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:106-112. [PMID: 28126372 PMCID: PMC9278876 DOI: 10.1016/j.pnpbp.2017.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/19/2016] [Accepted: 01/22/2017] [Indexed: 01/22/2023]
Abstract
Social anxiety disorder (SAD) is characterized by aberrant prefrontal activity during reappraisal, an adaptive cognitive approach aimed at downregulating the automatic response evoked by a negative event. Cognitive behavioral therapy (CBT) is first-line psychotherapy for SAD, however, many remain symptomatic after treatment indicating baseline individual differences in neurofunctional activity may factor into CBT outcome. An emotion regulation strategy practiced in CBT is cognitive restructuring, a proxy for reappraisal. Therefore, neural response during reappraisal may serve as a brain-based predictor of CBT success. Prior to 12weeks of individual CBT, 34 patients with SAD completed a validated emotion regulation task during fMRI. Task instructions included 'Reappraise,' that is, use a cognitive approach to reduce affective state to a negative image, which was contrasted with looking at a negative image ('Look'). Regression results for Reappraise (vs. Look) revealed greater reduction in symptom severity was predicted by less pre-CBT activation in the dorsolateral prefrontal cortex (DLPFC). Regarding predictive validity, DLPFC significantly classified responder status. Post-hoc analysis revealed DLPFC activity, but not demographic data, baseline clinical measures, or reappraisal-related affective state during fMRI, significantly accounted for the variance in symptom reduction. Findings indicate patients with SAD are more likely to benefit from CBT if there is less pre-treatment DLPFC recruitment, a region strongly implicated in emotion regulation. Patients with reduced baseline frontal activation when reappraising negative stimuli may be especially helped by explicit cognitive interventions. Further research is necessary to establish DLPFC as a stable brain-based marker of treatment outcome.
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28
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Saunders R, Cape J, Fearon P, Pilling S. Predicting treatment outcome in psychological treatment services by identifying latent profiles of patients. J Affect Disord 2016; 197:107-15. [PMID: 26991365 DOI: 10.1016/j.jad.2016.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The outcomes of psychological therapies for anxiety and depression vary across individuals and symptom domains. Being able to predict treatment response from readily available patient data at presentation has potentially important benefits in aiding decisions about the most suitable interventions for a patient. This paper presents a method of identifying subgroups of patients using latent profile analysis, and comparing response to psychological treatments between these profiles. METHODS All outpatients taken into treatment at two psychological treatment services in London, UK and who provided basic demographic information and standardized symptom measures were included in the analysis (n=16636). RESULTS Latent Profile Analysis was performed on intake data to identify statistically different groups of patients, which were then examined in longitudinal analyses to determine their capacity to predict treatment outcomes. Comparison between profiles showed considerable variation in recovery (74-15%), deterioration rates (5-20%), and levels of attrition (17-40%). Further variation in outcomes was found within the profiles when different intensities of psychological intervention were delivered. LIMITATIONS Latent profiles were identified using data from two services, so generalisability to other services should be considered. Routinely collected patient data was included, additional patient information may further enhance utility of the profiles. CONCLUSIONS These results suggest that intake data can be used to reliably classify patients into profiles that are predictive of outcome to different intensities of psychological treatment in routine care. Algorithms based on these kinds of data could be used to optimize decision-making and aid the appropriate matching of patients to treatment.
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Affiliation(s)
- Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - John Cape
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), 1-19 Torrington Place, London WC1E 7HB, United Kingdom
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Ociskova M, Prasko J, Latalova K, Kamaradova D, Grambal A. Psychological factors and treatment effectiveness in resistant anxiety disorders in highly comorbid inpatients. Neuropsychiatr Dis Treat 2016; 12:1539-51. [PMID: 27445474 PMCID: PMC4928674 DOI: 10.2147/ndt.s104301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. SUBJECTS AND METHODS A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory - revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory - second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. RESULTS Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to backward-stepwise multiple regression, the best significant predictor of treatment effectiveness was the initial level of self-stigma. CONCLUSION The initial higher levels of self-stigma predict a lower effectiveness of treatment in resistant-anxiety-disorder patients with high comorbidity with depression and/or personality disorder. The results suggest that an increased focus on self-stigma during therapy could lead to better treatment outcomes.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Dana Kamaradova
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
| | - Ales Grambal
- Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic
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A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia. Clin Psychol Rev 2015; 42:179-92. [DOI: 10.1016/j.cpr.2015.09.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 08/11/2015] [Accepted: 09/18/2015] [Indexed: 11/22/2022]
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El Alaoui S, Hedman E, Ljótsson B, Lindefors N. Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive-behavioural therapy for social anxiety disorder in routine psychiatric care. BMJ Open 2015; 5:e007902. [PMID: 26105031 PMCID: PMC4479995 DOI: 10.1136/bmjopen-2015-007902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Although the short-term outcome of therapist-guided internet-based cognitive-behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representative conditions. Further, there is some debate whether delivering psychological treatment via the internet may be suitable for more severely ill patients. DESIGN Longitudinal multilevel growth-modelling of long-term (1-4 years) follow-up cohort data. SETTING An outpatient psychiatric clinic specialised in internet interventions. PARTICIPANTS 446 adults having been treated for SAD. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were estimated improvement rate and Cohen's d effect size on the self-rated Liebowitz Social Anxiety Disorder Scale. Secondary outcome measures were change in comorbid depressive symptoms and health-related quality of life. RESULTS A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). However, the rate of change varied significantly between individuals over time. A faster rate of improvement was observed among patients with higher illness severity, whereas having a family history of social anxiety was related to worse response. Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=-0.3 (95% CI -0.4 to -0.1)). CONCLUSIONS These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases.
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Affiliation(s)
- Samir El Alaoui
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Lindefors
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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El Alaoui S, Ljótsson B, Hedman E, Kaldo V, Andersson E, Rück C, Andersson G, Lindefors N. Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care. PLoS One 2015; 10:e0124258. [PMID: 25893687 PMCID: PMC4404057 DOI: 10.1371/journal.pone.0124258] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/11/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT) for social anxiety disorder (SAD), a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD. METHOD The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764) treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR) scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a) socio-demographic variables; (b) clinical characteristics; (c) family history of mental illness; and (d) treatment-related factors. RESULTS Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence. CONCLUSIONS Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist behaviours that promote adherence may be important for treatment response, although more research is needed in order to determine what type of support would be most beneficial.
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Affiliation(s)
- Samir El Alaoui
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Evelyn Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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Hoyer J, Wiltink J, Hiller W, Miller R, Salzer S, Sarnowsky S, Stangier U, Strauss B, Willutzki U, Leibing E. Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial. Clin Psychol Psychother 2014; 23:35-46. [PMID: 25504802 DOI: 10.1002/cpp.1936] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 11/09/2022]
Abstract
UNLABELLED We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed. METHOD Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied. RESULTS Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted. CONCLUSIONS The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level. KEY PRACTITIONER MESSAGE Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Juergen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Joerg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfgang Hiller
- Clinical Psychology and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Robert Miller
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Simone Salzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany
| | - Stephan Sarnowsky
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Ulrike Willutzki
- Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Eric Leibing
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany
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