RESUMO
INTRODUCTION: Topical corticosteroid (TCS) phobia may negatively impact treatment adherence. Currently, there are few studies exploring trust and knowledge of TCS use among pharmacy staff. The objective of this work was to examine TCS knowledge and possible phobia among Danish pharmacy staff. METHODS: A questionnaire, based on Topical Corticosteroid Phobia (TOPICOP©) questionnaire, was developed and rephrased to fit pharmacy staff. The questions were Likert scales and numerical rating scales (NRS) (0-10). In October/November 2021, 64 pharmacies were invited. If the pharmacies agreed to participate, a researcher visited the pharmacies and distributed the questionnaires. RESULTS: A total of 244 pharmacy workers from 59 pharmacies participated. The majority (95.4%) responded that they were aware of side effects of TCS; however, misconceptions regarding side effects were found in up to 34% of participants. Regarding TCS use, 40% sometimes advised the patients to wait as long as possible before initiating treatment with TCS. Confidence in dispensing TCS to patients was high, with a mean of 8.45 (NRS). CONCLUSION: Danish pharmacy staff generally reported high confidence in TCS use. Misconceptions regarding side effects were common, and there was a tendency to giving advices on TCS treatment that may indicate low confidence in TCS. Thorough education of pharmacy staff is needed to improve the knowledge of TCS.
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Corticosteroides , Humanos , Dinamarca , Feminino , Inquéritos e Questionários , Masculino , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Administração Tópica , Farmacêuticos , Pessoa de Meia-Idade , Transtornos Fóbicos/tratamento farmacológicoAssuntos
Corticosteroides , Dermatite Atópica , Adesão à Medicação , Humanos , Dermatite Atópica/tratamento farmacológico , Brasil , Masculino , Feminino , Adesão à Medicação/estatística & dados numéricos , Adulto , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Transtornos Fóbicos/tratamento farmacológico , Adulto Jovem , Adolescente , Pessoa de Meia-Idade , Estudos Transversais , Administração TópicaRESUMO
OBJECTIVE: Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS). MATERIALS AND METHODS: This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data. RESULTS: The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP. CONCLUSIONS: In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.
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Fármacos Dermatológicos , Transtornos Fóbicos , Dermatopatias , Líquen Escleroso Vulvar , Adulto , Humanos , Feminino , Líquen Escleroso Vulvar/complicações , Líquen Escleroso Vulvar/tratamento farmacológico , Estudos Transversais , Glucocorticoides/uso terapêutico , Corticosteroides/uso terapêutico , Transtornos Fóbicos/induzido quimicamente , Transtornos Fóbicos/complicações , Transtornos Fóbicos/tratamento farmacológicoRESUMO
OBJECTIVE: To determine the frequency of prescribing and the main therapeutic targets of Teraligen in the treatment of Schizotypal disorder (STD) in childhood and adolescence. MATERIAL AND METHODS: The sample consisted of 151 patients aged 7 to 16 years with a diagnosis of STD (F 21), of which 31.1% (n=47) of female patients and 68.9% (n=104) of male patients who received inpatient or outpatient treatment at the FSBI NCPZ from 2008 to 2020. The study was conducted by clinical-psychopathological, clinical-catamnestic, and statistical methods. RESULTS: Teraligen was prescribed by psychiatrists to patients with STD in 74.2% of cases, of which in 46.4% of cases patients received Teraligen even before the diagnosis of STD in connection with complaints of neurotic disorders (anxiety, fears and sleep disorders) (n=30), as well as in connection with autistic-like behavior (n=22). At the time of follow-up, 55% (n=83) of patients received Teraligen, of which 63.9% (n=53) of patients were prescribed it for the first time. The applied schemes of prescribing Teraligen for the treatment of anxiety-phobic, depressive and behavioral syndromes within the framework of the STD in a relatively age-related aspect are presented. CONCLUSION: The high frequency of prescribing Teraligen by psychiatrists and neurologists to children and adolescents with STD at different stages of observation is shown, which reflects the confidence of specialists in this drug. Teraligen has demonstrated a multidimensional pharmacological effect, including a mild antipsychotic effect, providing reduction of a wide range of psychopathological symptoms, with good tolerability and drug interaction. The study of the possibilities of Teraligen, both for monotherapy and for augmentation of the treatment of mental pathology in childhood, remains relevant.
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Transtorno da Personalidade Esquizotípica , Trimeprazina , Adolescente , Criança , Feminino , Humanos , Masculino , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/etiologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/etiologia , Transtorno da Personalidade Esquizotípica/complicações , Transtorno da Personalidade Esquizotípica/tratamento farmacológico , Transtornos Fóbicos/tratamento farmacológico , Transtornos Fóbicos/etiologia , Trimeprazina/uso terapêuticoRESUMO
PURPOSE: Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; fainting susceptibility) in healthy young adults. We hypothesized that pain associated with IV procedures would reduce OT. METHODS: In this randomised, double-blind, placebo-controlled, cross-over study, participants (N = 23; 14 women; age 24.2 ± 4.4 years) underwent head-up tilt with combined lower body negative pressure to presyncope on three separate days: (1) IV cannulation with local anaesthetic cream (EMLA) (IV + EMLA); (2) IV cannulation with placebo cream (IV + Placebo); (3) sham IV cannulation with local anaesthetic cream (Sham + EMLA). Participants rated pain associated with IV procedures on a 1-5 scale. Cardiovascular (finger plethysmography and electrocardiogram; Finometer Pro), and forearm vascular resistance (FVR; brachial Doppler) responses were recorded continuously and non-invasively. RESULTS: Compared to Sham + EMLA (27.8 ± 2.4 min), OT was reduced in IV + Placebo (23.0 ± 2.8 min; p = 0.026), but not in IV + EMLA (26.2 ± 2.2 min; p = 0.185). Pain was increased in IV + Placebo (2.8 ± 0.2) compared to IV + EMLA (2.0 ± 2.2; p = 0.002) and Sham + EMLA (1.1 ± 0.1; p < 0.001). Orthostatic heart rate responses were lower in IV + Placebo (84.4 ± 3.1 bpm) than IV + EMLA (87.3 ± 3.1 bpm; p = 0.007) and Sham + EMLA (87.7 ± 3.1 bpm; p = 0.001). Maximal FVR responses were reduced in IV + Placebo (+ 140.7 ± 19.0%) compared to IV + EMLA (+ 221.2 ± 25.9%; p < 0.001) and Sham + EMLA (+ 190.6 ± 17.0%; p = 0.017). CONCLUSIONS: Pain plays a key role in predisposing to VVS following venipuncture, and our data suggest this effect is mediated through reduced capacity to achieve maximal sympathetic activation during orthostatic stress. Topical anaesthetics, such as EMLA, may reduce the frequency and severity of VVS during procedures requiring needles and intravascular instrumentation.
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Transtornos Fóbicos , Síncope Vasovagal , Feminino , Adulto Jovem , Humanos , Adulto , Anestésicos Locais/uso terapêutico , Combinação Lidocaína e Prilocaína , Prilocaína/uso terapêutico , Lidocaína/uso terapêutico , Síncope Vasovagal/etiologia , Síncope Vasovagal/prevenção & controle , Estudos Cross-Over , Dor/etiologia , Dor/tratamento farmacológico , Método Duplo-Cego , Transtornos Fóbicos/tratamento farmacológicoRESUMO
Needle phobia is a specific phobia classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders-5, and can be a serious problem for patients requiring insulin injections. However, there have been few reports to date on the management of adults with diabetes and needle phobia. We here report a case of a woman with pancreatic diabetes who developed needle phobia and could no longer perform self-injections. She started to use a sensor-augmented pump (SAP), and was able to perform a puncture for the insulin pump and the continuous glucose monitoring sensor by herself. The SAP treatment achieved self-management, better glycemic control, and high treatment satisfaction quantified using the Diabetes Treatment Satisfaction Questionnaire in this patient. Our case suggests the therapeutic potential of SAP in adults with needle phobia and diabetes requiring insulin therapy.
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Diabetes Mellitus Tipo 1 , Transtornos Fóbicos , Adulto , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Glicemia , Automonitorização da Glicemia , Insulina/uso terapêutico , Transtornos Fóbicos/tratamento farmacológicoRESUMO
INTRODUCTION: Exposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE). METHODS: Children and young people with a specific phobia (SP) (N = 50, age 8-17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS: Within exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one's individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises. DISCUSSION: SmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.
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Transtornos Fóbicos , Adolescente , Criança , Feminino , Humanos , Masculino , Medo , Transtornos Fóbicos/tratamento farmacológico , Método Simples-Cego , Resultado do TratamentoRESUMO
Despite being an inert treatment, placebo has been repeatedly shown to induce the experience of automatic symptom relief, a therapeutic effect over which a person has no control. We tested whether a placebo that participants believed was an active drug would induce them to take action to overcome their symptomatic impairment, a self-efficacious role we term an activating placebo effect. Specifically, we tested whether a placebo presented to spider-phobic participants as a fear-reducing drug would induce them to approach a live tarantula. Sixty spider-phobic participants, identified by a fear questionnaire and assessing their approach behavior toward a live tarantula, were randomized to take a placebo, presented either as propranolol or a placebo, or to a no-treatment control group. Participants who believed the placebo was propranolol increased in their willingness to approach the tarantula, and actually moved physically closer to it, relative to the other two groups. They did so despite experiencing higher levels of fear, and subsequently improved in their self-efficacy beliefs about tolerating fear when encountering a spider. Changes in willingness to approach the tarantula mediated changes in approach behavior, which in turn mediated changes in self-efficacy. These results represent the first explicit demonstration of an activating placebo effect.
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Transtornos Fóbicos , Aranhas , Animais , Medo , Humanos , Transtornos Fóbicos/tratamento farmacológico , Efeito Placebo , Propranolol/uso terapêuticoRESUMO
ABSTRACT: Misophonia is an adverse physical and emotional reaction to certain repetitive trigger sounds, usually generated by other people. Misokinesia refers to visual triggers that are sometimes (but not always) related to trigger sounds. Despite how common and disabling these conditions can be, medication treatment of misophonia and misokinesia is largely unexplored. We present the first case of using a ß-blocker (propranolol) to successfully treat a patient experiencing misophonia and misokinesia. A moderate dose (60 mg) of propranolol completely eliminated multiple auditory and visual trigger symptoms related to other people eating. His trigger response symptoms included overwhelming negative emotions and prominent sympathetic overactivity (fight-or-flight response). These symptoms were so severe that he had avoided most meals with friends and family for the past several years. Propranolol eliminated the emotional and physiological effects of both the auditory and visual triggers, with an Amsterdam Misophonia Scale score reduction from 15 to 2. This enabled him to resume eating meals with family and friends with no distress. The medication was well tolerated. In summary, we report the novel finding that ß-blockers were markedly effective at treating the physical and emotional symptoms of a patient with misophonia and misokinesia. This suggests a novel treatment approach for these conditions.
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Antagonistas Adrenérgicos beta , Hiperacusia , Transtornos Fóbicos , Antagonistas Adrenérgicos beta/uso terapêutico , Humanos , Hiperacusia/tratamento farmacológico , Masculino , Transtornos Fóbicos/tratamento farmacológicoRESUMO
BACKGROUND: Topical corticosteroid (TCS) phobia is a fear of steroids, most prevalent among the general steroid users, the origin of anxiety and fear about steroids is still unclear. Although multiple studies have been using the validated TOPICOP© scale to assess the scores of steroid phobia in various skin disorders. OBJECTIVES: The aim of the study was to analyze the steroid phobia among users of topical corticosteroids and also to assess the association between demographical characteristics and TCS phobia. METHODS: A cross-sectional survey was conducted to evaluate the belief and perspectives of TCS in a large range of patients of both genders of all ages. Patients presenting in dermatology clinic with any dermatological complaint, who were being treated or currently on topical steroids were included. TOPICOP© scale was used to assess the topical steroid phobia. RESULTS: A total of 221 topical steroid users were selected for this study, among them 56 (26.7%) were male and 162 (73.3%) were female. The median of global TOPICOP score was 18% and CI 22-12%, S.D: 6.23. The median score of knowledge and beliefs was 7%, (IQR: 9-4%), S.D: 3.33, while fear showed median 5% (IQR: 7-3%), S.D: 2.24, and 6% (IQR: 8-4%), S.D:2.4 for behavior 96 (43.4%). Patients who were not well aware of steroids but still afraid of using steroids. 112 (50.7%) acknowledged the non-adherence to treatment. CONCLUSION: Steroid phobia is more prevalent among uneducated users of topical steroids than among those who are knowledgeable and literate. Healthcare practitioners should counsel their patients about steroids use and related concerns, rather than addressing the issue that is causing fear in patients.
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Fármacos Dermatológicos , Dermatologia , Transtornos Fóbicos , Administração Tópica , Estudos Transversais , Fármacos Dermatológicos/efeitos adversos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Paquistão , Transtornos Fóbicos/tratamento farmacológico , Esteroides , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Storm phobia in companion dogs is a common disorder that significantly impacts dogs' welfare. Gabapentin, the action of which is only partially understood, is widely used for its antiepileptic and analgesic properties. Only recently, the veterinary community began to use gabapentin to address phobia and anxiety in dogs. This study tested gabapentin to lower fear responses of dogs during a thunderstorm event. METHODS: Eighteen dogs suffering from storm phobia completed our double-blind, placebo-controlled crossover trial. Each dog's behaviour was evaluated twice by his owner: once under placebo, once under gabapentin. The treatment was orally administered at least 90 min before the exposure. Gabapentin was given at a dose ranging from 25 to 30 mg/kg. RESULTS: Our results indicate a significant reduction of the fear responses of dogs under gabapentin. The adverse effects were rare, and the most frequent amongst them was ataxia. CONCLUSION: In this trial, gabapentin appears to be an efficient and safe molecule that should be considered as part of the treatment plan of storm phobia in dogs.
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Ácidos Cicloexanocarboxílicos , Transtornos Fóbicos , Aminas/uso terapêutico , Analgésicos/uso terapêutico , Animais , Estudos Cross-Over , Ácidos Cicloexanocarboxílicos/uso terapêutico , Cães , Método Duplo-Cego , Gabapentina/uso terapêutico , Transtornos Fóbicos/tratamento farmacológicoRESUMO
Background Besides physicians, pharmacy staff has an important role to inform patients on appropriate medication use. However, they might also experience corticophobia themselves, affecting patient counseling and subsequently patient's disease management. Objective Implementation of an intervention for pharmacy staff to improve knowledge and stimulate positive perceptions towards TCS use, in order to reduce corticophobia in pharmacy staff and parents of young AD patients. Setting Nine community pharmacies in the Netherlands. Method We developed an intervention consisting of education of pharmacy staff followed by counseling of parents. The intervention was implemented in pharmacies and intervention effectiveness was studied using a pre-post design with an intervention period of 3 months. At baseline and follow-up (3 months), pharmacy staff and parents completed a questionnaire. Main outcome measure Corticophobia, both beliefs and worries, measured with the TOPICOP questionnaire. Higher scores indicate a more negative attitude. Result Baseline and follow-up data were available for 19 pharmacy staff members and 48 parents who attended a counseling session in the pharmacy. In both groups there was as decrease in negative beliefs and worries towards TCS (p < 0.05). Mean total TOPICOP scores decreased from 42 to 35% and from 33 to 25% for parents and pharmacy staff respectively. Conclusion Our results show the prevalence of corticophobia among parents. Education of pharmacy staff and targeted patient counseling seems to be effective in reducing corticophobia.
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Serviços Comunitários de Farmácia , Dermatite Atópica , Farmácias , Farmácia , Transtornos Fóbicos , Corticosteroides , Criança , Humanos , Pais , Transtornos Fóbicos/tratamento farmacológico , Transtornos Fóbicos/epidemiologiaRESUMO
BACKGROUND: Atopic dermatitis (AD) is a prevalent relapsing inflammatory skin disease. There is currently little knowledge about healthcare utilization and medication use along with parental corticosteroid phobia in relation to severity of pediatric AD. OBJECTIVES: To study the association between parental-reported healthcare utilization, medication use, and topical corticosteroid phobia and pediatric AD severity. METHODS: The study population included all children in Denmark with a diagnostic code of AD (ICD-10 code, group L20) given at a hospital department of dermatology between 2014 and 2018. A questionnaire containing 158 response items was sent to the legal parents. We surveyed disease severity, AD treatment, corticosteroid phobia, and healthcare use along with other variables. Disease severity was assessed using the Patient-Oriented Eczema Measure tool, and corticosteroid phobia was assessed using the Topical Corticosteroid Phobia (TOPICOP) score. RESULTS: In total, 1343 (39%) parents completed the questionnaire and 95.3% were completed by the biological mother. Children's mean age was 8.9 ± 4.5 years, and 52.8% were boys. Severe AD was associated with a higher number of healthcare visits to GPs, private dermatologists, and hospital departments. Mean global TOPICOP score was 38.27 ± 19.9%. There was a significant inverse linear trend between global TOPICOP score and parental educational level (Ptrend < .0005). CONCLUSIONS: The significant association between high global TOPICOP score and low parental educational level, resulting in delayed treatment of AD flares, indicates that improved family education ultimately may reduce healthcare expenses and burden of disease.
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Dermatite Atópica , Eczema , Transtornos Fóbicos , Corticosteroides/uso terapêutico , Criança , Dinamarca/epidemiologia , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Humanos , Masculino , Pais , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Fóbicos/tratamento farmacológico , Transtornos Fóbicos/epidemiologiaRESUMO
BACKGROUND: Ketamine has rapid anxiolytic effects in treatment-resistant obsessive compulsive, post-traumatic stress, generalised anxiety and social anxiety disorders. OBJECTIVES: This study aimed to assess changes following acute and maintenance ketamine therapy on the Fear Questionnaire (FQ) subscales and the Spielberger State Anxiety Inventory (SSAI). METHODS: This secondary analysis used data from a mixed open-label and double-blinded placebo-controlled study. A total of 24 patients received short-term ascending subcutaneous doses of ketamine and were then eligible to enter a 3-month maintenance phase of 1 mg/kg ketamine dosed once or twice weekly. FQ and SSAI data were analysed using mixed models to identify between-dose differences and to describe trends during maintenance. RESULTS: Acute ketamine dosing showed a rapid dose-related reduction in all three FQ subscales (agoraphobia, social phobia and blood-injury phobia) and in the SSAI. A progressive decrease in pre-dose rating-scale scores was evident during the 3 months of maintenance therapy. CONCLUSIONS: Ketamine demonstrated dose-related improvements in all FQ subscales and in the SSAI. Both scales appear to be suitable tools to assess the anxiolytic effects of ketamine in patients with treatment-resistant anxiety. Furthermore, ketamine appears to have broad, dose-related anti-phobic effects. These findings raise the possibility that ketamine may have therapeutic potential in the treatment of other phobic states, such as specific phobia.
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Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Medo/efeitos dos fármacos , Ketamina/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Método Duplo-Cego , Feminino , Humanos , Masculino , Fobia Social/tratamento farmacológico , Transtornos Fóbicos/tratamento farmacológico , Psicometria/métodos , Inquéritos e QuestionáriosRESUMO
Trypophobia is a clinical entity that is characterized by unpleasant feelings related to or an aversion to irregular patterns of small holes or bumps. There are insufficient data about the etiological factors underlying trypophobia. It has been associated with anxiety disorders because it shows comorbidity and symptom similarity with anxiety disorders. Literature on the treatment strategies of trypophobia is somewhat limited. In this case report, we present an adolescent girl with trypophobia that is successfully treated with sertraline.
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Transtornos Fóbicos/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Adolescente , Feminino , Humanos , Inquéritos e QuestionáriosRESUMO
Glucocorticoids reduce phobic fear in anxiety disorders and enhance psychotherapy, possibly by reducing the retrieval of fear memories and enhancing the consolidation of new corrective memories. Glucocorticoid signaling in the basolateral amygdala can influence connected fear and memory-related cortical regions, but this is not fully understood. Previous studies investigated specific pathways moderated by glucocorticoids, for example, visual-temporal pathways; however, these analyses were limited to a-priori selected regions. Here, we performed whole-brain pattern analysis to localize phobic stimulus decoding related to the fear-reducing effect of glucocorticoids. We reanalyzed functional magnetic resonance imaging (fMRI) data from a previously published study with spider-phobic patients and healthy controls. The patients received glucocorticoids or a placebo before the exposure to spider images. There was moderate evidence that patients with phobia had higher decoding of phobic content in the anterior cingulate cortex (ACC) and the left and right anterior insula compared to controls. Decoding in the ACC and the right insula showed strong evidence for correlation with experienced fear. Patients with cortisol reported a reduction of fear by 10-13%; however, there was only weak evidence for changes in neural decoding compared to placebo which was found in the precuneus, the opercular cortex, and the left cerebellum.
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Córtex Cerebral/efeitos dos fármacos , Medo/efeitos dos fármacos , Glucocorticoides/farmacologia , Memória/efeitos dos fármacos , Transtornos Fóbicos/tratamento farmacológico , Adulto , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Córtex Cerebral/fisiopatologia , Feminino , Giro do Cíngulo/efeitos dos fármacos , Giro do Cíngulo/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos Fóbicos/fisiopatologia , AranhasRESUMO
BACKGROUND AND OBJECTIVES: In anxiety disorders, cognitive behavioural therapy (CBT) improves information-processing biases such as implicit fear evaluations and avoidance tendencies, which predicts treatment response. Thus, these cognitive biases might constitute important treatment targets. This study investigated (i) whether information-processing biases could be changed following single-session computerised CBT for spider fear, and (ii) whether this effect could be augmented by administration of D-cycloserine (DCS). METHODS: Spider-fearful individuals were randomized to receiving either 250 mg of DCS (n = 21) or placebo (n = 17). Three hours after drug administration, they received single-session computerized CBT, characterized by psychoeducation and exposure elements. Spider fear was assessed using self-report, behavioural, and information processing (Extrinsic Affective Simon Task & Approach Avoidance Task) measures at baseline (before drug administration), post-treatment, 1-day, and 1-month follow-up. RESULTS: Linear mixed-effects analyses indicated significant improvements on self-report and behavioural spider fear indices following CBT, but not on cognitive bias measures. There was no evidence of an augmentation effect of DCS on any outcome. Cognitive bias measures at 1-day were not predictive of 1-month follow-up spider fear in adjusted linear regression analyses. LIMITATIONS: Results might be biased by limited representativeness of the sample (high education and intelligence, largely Caucasian ethnicity, young age). The study was also only powered for detection of medium-sized DCS effects. CONCLUSIONS: These findings do not provide evidence for information-processing biases relating to treatment outcome following computerised CBT for spider fear or augmentation with DCS.
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Cognição/efeitos dos fármacos , Terapia Cognitivo-Comportamental , Ciclosserina/farmacologia , Ciclosserina/uso terapêutico , Medo/efeitos dos fármacos , Transtornos Fóbicos/psicologia , Transtornos Fóbicos/terapia , Aranhas , Adulto , Animais , Terapia Combinada , Feminino , Humanos , Masculino , Transtornos Fóbicos/tratamento farmacológicoRESUMO
BACKGROUND: Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence-based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group-based ACT for FCR in BCS. METHODS: Post-treatment BCS (91 patients with stage I-III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2-hour group sessions), survivorship education (SE; 6 weekly 2-hour group sessions), or enhanced usual care (EUC; one 30-minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post-traumatic stress, depression, QOL, and other FCR-related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent-to-treat analysis. RESULTS: Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within-group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between-group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within-group reductions across all time points. By T4, significant moderate to large between-group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR-related psychological distress. CONCLUSIONS: Group-based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.