Cognitive-behavioral therapy of panic disorder with secondary major depression: a preliminary investigation.

Controlled studies indicate that cognitive-behavioral therapy eliminates panic attacks in greater than 80% of patients who suffer from panic disorder. However, because most of the screening procedures used in those studies called for excluding patients who were depressed, a question arises as to the extent to which these results apply to patients who are clinically depressed in addition to having panic attacks. Accordingly, an attempt was made in the present study to determine whether or not panic patients who are clinically depressed could be treated as successfully as those who are not clinically depressed. Two multiple baseline A-A1-A-B across-subjects designs were used, one to test 8 panic Ss with major depression and the second to test 7 panic Ss without major depression. In Baseline (A), Ss monitored their panic attacks daily. During the A1 phase, a program of information on panic attacks presented as psychotherapy was instituted to assess the effects of nonspecific factors, followed by a second baseline phase (A). Cognitive-behavioral therapy (B) was then introduced. Results showed that cognitive-behavioral therapy was significantly superior to information-based therapy in the reduction of panic attacks. No significant differences were found between depressed and nondepressed patients.

The assessment of panic using self-report: a comprehensive survey of validated instruments.

A repertoire of reliable and valid self-report instruments to assess panic and panic disorder would help both researchers and clinicians. This review presents a description and an analysis of the available instruments. Following a comprehensive search of the literature, 14 instruments with published information on reliability and validity were reviewed. The following information is reported for each instrument: brief description of the instrument and its development, mean and standard deviation for clinical and nonclinical samples, and psychometric properties. Four types of instruments are presented: general assessment and information (n = 2), severity of panic disorder (n = 2), body sensations (n = 2) and cognitive dimensions of panic (n = 8). Overall, it would seem that panic measures have moderate to excellent psychometric qualities. However, the comparison between the instruments is difficult because the amount of empirical support available varies widely from one instrument to the other.

Long-term effects of biofeedback on migraine headache: a prospective follow-up study.

The aim of the present study was two-fold: to assess the long-term effects of biofeedback on migraine, and to determine the extent to which additional treatment after biofeedback treatment is completed can affect follow-up results. Ninety-six women whose migraine had been treated through biofeedback either 2-3 years (shorter follow-up) or 6-7 years (longer follow-up) earlier were divided into four groups according to how long ago they had received their biofeedback treatment and whether or not they had received any additional treatment (whatever the nature) since the posttreatment assessment: shorter follow-up without additional treatment (n = 24), shorter follow-up with additional treatment (n = 22), longer follow-up without additional treatment (n = 24), and longer follow-up with additional treatment (n = 26). Subjects were asked to keep a headache diary for five weeks, as they had done during earlier assessments. Overall, results showed that migraine activity was significantly less at follow-up than at pretreatment. However, whether the observed long-term benefits could be attributed to biofeedback was unclear because medication was found to be as much in use at follow-up as at pretreatment. Results also indicated that 51% of the subjects did seek additional treatment between posttreatment and follow-up. Contrary to expectations, however, additional treatment was not associated with better therapeutic benefits at follow-up. The research and the clinical implications of those findings are discussed.

The differential effects of biofeedback in the treatment of menstrual and nonmenstrual migraine.

The aim of the present study was to investigate the effects of biofeedback training in the treatment of menstrual and nonmenstrual migraine. Accordingly, 39 female patients suffering from both migraine associated, and migraine not associated, with menstrual periods were drawn from a pool of research volunteers enrolled in a biofeedback treatment program for migraine headaches. All patients were required to complete 5 weeks of daily self-monitoring of headache and menstruation activity immediately before and after treatment, and again at 6-month follow-up. Within-subjects comparisons of the effects of biofeedback on menstrual and nonmenstrual migraine, and between-subjects comparisons of the effects of biofeedback on patients suffering predominantly from either menstrual or nonmenstrual migraine showed that biofeedback is just as effective in reducing menstrual migraine as it is in reducing nonmenstrual migraine. Questions as to whether or not these conclusions can apply to patients who experience migraine headaches only during, or shortly before or after, menstruation, are raised.

[Concomitant and discriminatory validity of the Adolescents' Fear of Dental Treatment Cognitive Inventory]. / La validité concomitante et discriminante de l'Inventaire cognitif de la peur des traitements dentaires pour adolescent(e)s.

The revised edition of the Inventaire cognitif de la peur des traitements dentaire pour adolescent(e)s [Adolescents' Fear of Dental Treatment Cognitive Inventory] (ICPTD-A) was administered to 38 subjects chosen at random and to nine subjects chosen with an obvious dental phobia problem. Its concomitant validity was established by relating the ICPTD-A scores to those of a behavioral test. The Pearson correlation coefficients that were thus obtained were -0.66 for the general population and -0.87 for the population suffering from dental phobia. The discriminatory validity was then established with a repeated measurement variance analysis based on the scores of the dental phobics after the administration of a recognized psychological treatment program intended to reduce their phobia. The results have shown a statistically significant difference between the experimental and control groups as well as a significant difference between pre- and posttreatments. The authors have therefore concluded that the ICPTD-A is a valid tool for the assessment of dental phobia in 12-15-year-old adolescents.

[Adolescents' fear of dental treatment: development and evaluation of a cognitive inventory]. / La peur des traitements dentaires chez les jeunes adolescents: développement et évaluation d'une mesure cognitive.

Morin et al.'s Inventaire cognitif de la peur des traitements dentaires pour adolescent(e)s [Adolescents' Fear of Dental Treatment Cognitive Inventory] was administered to 343 subjects. Factor analysis revealed a single general factor that accounted for 33.5 per cent of the total variance. A reliability test revealed an alpha coefficient of 0.91, which was quite acceptable. A measure of test-retest reliability over a four-week period (N = 181) indicated that the scale was stable over time (r = 0.85). Standard error of measurement was found to be 4.63. Normative data are provided along with a description of the final version of the scale.

Evaluating anxiety and depression in HIV-infected patients.

Because there is a large overlap between HIV manifestations and somatic symptoms of anxiety and depression, it is crucial to use measures that do not contain somatic items to validly and reliably assess these psychological states in HIV-infected patients. The purpose of this study was to assess the psychometric properties of the Hospital Anxiety and Depression Scale (HADS), a questionnaire that does not include any somatic items, in HIV-seropositive individuals. Because the study was conducted among French Canadian individuals, the quality of the translation was 1st subjectively and empirically assessed. Then, the psychometric properties of the HADS were evaluated in 162 HIV-seropositive patients, who, in addition to the HADS, also completed the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory. The French Canadian version used was found to be subjectively and empirically equivalent to the original English version. Moreover, results of this study demonstrated a bifactorial structure with factors corresponding to the HADS subscales, an excellent internal consistency and test-retest reliability, a very good convergent validity, and an acceptable discriminant validity. Strikingly, in contrast to the BDI, HADS scores were found to be unconfounded by the presence of HIV symptomatology. The HADS appears to represent the best currently available self-report scale to reliably and validly assess anxiety and depression in HIV-infected patients. The HADS is simple and brief to administer (14 items) and may therefore be easily implemented in routine HIV care.