Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy.

Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy.

Resilience and coping strategies in cognitive behavioral group therapy for patients with panic disorder.

BACKGROUND: Although resilience and coping are important factors associated with mental health, they are rarely investigated in the treatment of patients with panic disorder (PD). OBJECTIVE: To evaluate the response to four resilience and coping strategy sessions added to the standard cognitive behavioral group therapy (CBGT) protocol for PD. DESIGN: Controlled clinical trial. METHODS: The control group (n = 50) attended 12 CBGT sessions, while the intervention group (n = 50) received four additional resilience and coping strategy sessions, i.e., 16 in total. Symptom severity, resilience, coping strategies, and quality of life were assessed at baseline and post-CBGT. RESULTS: Symptom severity and maladaptive coping strategies decreased significantly in both groups. However, the intervention group had increased resilience and improvement in the environment domain of quality of life. CONCLUSIONS: Additional sessions have potential benefits for coping skills and resilience in PD patients, but these benefits should be evaluated in further long-term studies.

Can Religious Coping and Depressive Symptoms Predict Clinical Outcome and Quality of Life in Panic Disorder? A Brazilian Longitudinal Study.

Few studies have investigated the relationship between spiritual/religious coping (S/R coping) and panic disorder (PD). This Brazilian longitudinal study evaluated if S/R coping and depressive symptoms can predict PD remission and improved quality of life (QoL). There were 101 outpatients with PD who were followed up for 12 to 16 weeks. The prevalence ratio (PR) between positive S/R coping and negative S/R coping and PD remission was assessed, as well as the association between positive S/R coping and negative S/R coping and QoL. After adjusting for confounding factors, positive S/R coping presented an inverse PR with PD remission, which was not statistically significant (0.88; p = 0.075). There was no association between S/R coping and QoL. Depressive symptoms were negatively associated with PD remission (PR = 0.97; p < 0.01) and were not predictive of a better QoL.

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

BACKGROUND: Investigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive-behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce. OBJECTIVES: To identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT. DESIGN: Non-controlled clinical trial. METHODS: A 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors. RESULTS: The sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors. CONCLUSIONS: Therapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.

Patient Rating of Therapeutic Factors and Response to Cognitive-Behavioral Group Therapy in Patients with Obsessive-Compulsive Disorder.

Group therapy involves complex mechanisms that rely on certain therapeutic factors to promote improvement. The objective of this study was to assess patient rating of therapeutic factors during cognitive-behavioral group therapy (CBGT) and to investigate the correlation between patient rating and outcome of CBGT for the treatment of obsessive-compulsive disorder (OCD). In the present clinical trial, 15 patients participated in a 12-session CBGT protocol. Severity of symptoms was assessed before and after CBGT with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A), and Beck Depression Inventory (BDI). Yalom's Curative Factors Questionnaire was administered at the end of each session for patient rating of the usefulness of 12 therapeutic factors to treat OCD. There was a significant interaction between improvement in obsessive-compulsive symptoms and patient rating of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding, and existential factors over time. The results show that group therapeutic factors positively influence the response to CBGT in OCD patients.

Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated (FAS-IR), Brazilian Portuguese version: internal consistency, reliability, and exploratory factor analysis.

OBJECTIVE: To examine the psychometric properties of the Brazilian Portuguese version of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated (FAS-IR). METHOD: A total of 114 family members of patients with obsessive-compulsive disorder (OCD) were assessed. The following analyses of the FAS-IR were carried out: internal consistency, inter-rater and test-retest reliability, and exploratory factor analysis. RESULTS: The Brazilian Portuguese version of the FAS-IR showed excellent inter-rater reliability (intraclass correlation coefficient [ICC]=0.94) and acceptable test-retest reliability (ICC=0.77), with no significant differences in FAS-IR scores. Factor analysis produced three factors for the scale. However, factor loadings were not well defined within each factor, and the factors did not have distinct constructs. Thus, a global analysis approach was chosen, revealing good internal consistency of the scale as a whole (Cronbach's α=0.805). CONCLUSIONS: The Brazilian Portuguese FAS-IR showed sound psychometric properties for the evaluation of family accommodation, and is, therefore, a reliable instrument for use in research and clinical practice.

Family burden and family environment: comparison between patients with panic disorder and with clinical diseases.

AIMS: The objective of this study was to compare the family burden and environment of patients with panic disorder (PD) with those of a control group composed of relatives of patients with clinical diseases. METHODS: A cross-sectional study was performed with 67 relatives of patients with PD, and 66 family members of patients with clinical diseases. All patients were administered a set of instruments to assess family burden and environment. RESULTS: Multivariate analyses revealed significant between-group differences on measurements of objective and subjective burden, both of which can be influenced by kinship, since higher levels of family burden tend to be reported by the children of the affected individual. Levels of family burden also tend to be associated with the severity of PD symptoms. CONCLUSIONS: The assessment of family burden may be useful in developing family-focused therapeutic strategies and may contribute to the improvement of patient outcomes.

Booster Sessions after Cognitive-Behavioural Group Therapy for Panic Disorder: Impact on Resilience, Coping, and Quality of Life.

BACKGROUND: Panic disorder (PD) has a chronic nature, especially as a result of maladaptive coping strategies to deal with stressful events. AIMS: To evaluate the impact of booster sessions with cognitive techniques on coping strategies, resilience, and quality of life (QoL) in patients previously submitted to standard cognitive-behavioural group therapy (CBGT) for PD. METHOD: A controlled clinical trial with 44 patients with PD (intervention = 20; control = 24) who had previously completed a 12-week CBGT protocol. PD, anxiety, and depression severity symptoms were assessed at baseline and 1, 6, and 12 months after the booster sessions. Coping strategies, resilience, and QoL were assessed by Coping Strategies Inventory (CSI), Resilience Scale, and WHOQOL-BREF respectively. RESULTS: Over time, a significant improvement in PD and depression symptoms was observed in both groups. A significant increase in the QoL social relations domain was found in the booster group, considering a time/group interaction. Coping and other QoL domains did not change after the booster sessions. Changes in resilience were dependent on the intensity of symptoms, with negative but non-significant correlations. CONCLUSIONS: The improvement in PD and depression symptoms for both groups may be a result of the group format of the intervention. Group booster sessions after CBGT are useful to maintain the benefits obtained with CBGT.

Effect of cognitive-behavioral group therapy for panic disorder in changing coping strategies.

BACKGROUND: Cognitive-behavioral group therapy (CBGT) is an efficient treatment for panic disorder (PD). However, the role of CBGT in enhancing strategies to cope with stressful events has not been established. AIM: To evaluate the effect of CBGT on the choice of coping strategy by PD patients compared to a group of individuals without mental disorders. METHODS: Forty-eight PD patients who completed a 12-session CBGT protocol were compared to 75 individuals without mental disorders regarding coping strategies as evaluated by the Coping Strategies Inventory (CSI). The severity of PD was assessed at baseline and after CBGT through the Clinical Global Impression (CGI) scale, the Hamilton Anxiety Scale (HAM-A), and the Panic Inventory (PI). RESULTS: Treatment was effective in reducing PD severity in all outcome measures. Patients used significantly fewer confrontation, escape and avoidance strategies after CBGT. The use of more adaptive coping strategies was related to a decrease in panic attacks and anticipatory anxiety. Application of the CSI showed that the use of strategies was also significantly different in patients as compared to the control group, except for escape and avoidance, which became similar after the CBGT protocol. CONCLUSIONS: Despite the changes observed after the CBGT protocol, the choice of coping strategy was still different in patients vs. controls. The current CBGT protocol was used specifically to assess PD symptoms. Other cognitive tools should be included to address maladaptive coping strategies.

Determinants of quality of life in elderly patients of a psychosocial care center in Brazil.

The purpose of the present study was to identify the sociodemographic, clinical, and functional determinants of quality of life in elderly (older than 60 years) patients from a Psychosocial Care Center. The sample was randomly selected patients undergoing treatment at the center during the study period. Quality of life was assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and the World Health Organization Quality of Life Assessment for older adults (WHOQOL-OLD). A total of 50 elderly individuals with a mean age of 67.5 (SD = 5.72) years were included in the study. A hierarchical linear regression showed that clinical characteristics, such as severe symptoms of depression and a higher number of comorbidities, were related to lower quality of life. Better functional capacity and more frequent visits to the center were determinants of higher quality of life. These findings underscore the importance of assessing quality of life and of taking this variable into account when planning health interventions for elderly patients at a Psychosocial Care Center.

Cognitive-behavioral group therapy for youths with anxiety disorders in the community: effectiveness in low and middle income countries.

BACKGROUND: Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). AIMS: To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. METHOD: A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a cross-sectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, self- and parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). RESULTS: Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. CONCLUSIONS: Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.

Quality of life determinants in patients of a Psychosocial Care Center for alcohol and other drug users.

Quality of life assessments in patients receiving treatment for substance dependence can serve as one predictor of response to treatment. This study aimed to identify determinants of quality of life in patients of a Psychosocial Care Center for alcohol and other drug users (CAPSad). The sample consisted of 77 patients with a diagnosis of substance dependence being treated at CAPSad for more than six months. Severity of substance dependence was assessed using the Addiction Severity Index (ASI-6), quality of life was assessed using the World Health Organization Quality of Life assessment instrument-short version (WHOQOL-BREF), and depressive symptoms were assessed by the Beck Depression Inventory (BDI). Data on CAPSad activities, psychiatric diagnoses, and medications used were collected from the medical records. Quality of life was significantly impaired in more severe cases of substance dependence and in those with more severe depressive symptoms. As for other variables, poorer quality of life was significantly associated with a greater number of years of education, unemployment, use of medications, and greater use of individual sessions with the reference professional. Linear regression analysis revealed depressive symptom severity to be an independent determinant of quality of life impairment, accounting for over 50% of the variation in physical and psychological domains. These results demonstrate the need to consider other factors, such as depressive symptoms and quality of life, in the treatment of substance dependence.

[Accuracy of nursing interventions for patients with type 2 diabetes mellitus in outpatient consultation]. / Acurácia das intervenções de enfermagem para pacientes com diabetes mellitus tipo 2 em consulta ambulatorial.

The objective of this study was to identify the accuracy of nursing interventions from the nursing diagnoses (ND) of patients who consulted in the Program for Diabetes Education, in outpatient care of the university hospital relating them with sociodemographic characteristics and comorbidities. It was a cross-sectional study of 136 patients with type 2 diabetes mellitus (DM2), with 77 (57%) women, with an average age of 66 +/- 9.38 years, and the presence of comorbidities in 97 (71%), and using medications. A significant association was found between the NDs and the most frequently prescribed interventions. "nutritional counseling" (n=99; 73%), "promotion of exercise" (n=64; 47%) and "teaching: feet care (n=48; 35%); however, not with the sociodemographic characteristics or comorbidities. The interventions most prescribed in nursing consultations showed ND accuracy for the domains of Promotion of Health and Nutrition, which are related to the principles of treatment for DM2: healthy eating, physical exercise and health education.

[Characteristics of pregnant women cared for in a visit to the prenatal outpatient nursing service: comparison of four decades]. / Características de gestantes atendidas em consulta de enfermagem ambulatorial de pré-natal: comparação de quatro décadas.

The aim of the work was to identify characteristics of pregnant women cared for by an obstetric nurse in a visit to the prenatal outpatient nursing service and compare these over the period from 1972 to 2009. Sociodemographic and obstetric data were collected from the forms completed by the pregnant patients during their visit to the nursing service. A total of 1245 forms were analyzed 208 (16.7%) being from the 1970s, 323 (25.9%) from the 1980s, 329 (26.4%) from the 1990s, and 385 (30.0%) from year 2000. A significant difference was found between the previous decades and year 9000 in relation to the greater number of high-risk pregnancies, number of nursing consultations and obstetric ultrasounds performed during the prenatal exam. The characteristics of pregnant women were observed to change over time, as well as the care provided by the obstetric nurse during visits to the outpatient nursing service, remaining associated with the demands of patients and legal resolutions.

[Outpatient nursing consultation and nursing diagnoses related to demographic and clinical characteristics]. / Consulta de enfermagem ambulatorial e diagnósticos de enfermagem relacionados a características demograficas e clínicas.

This study was aimed at verifyjing the relationship between demographic and clinicalfeatures and nursing diagnoses established during a nurse consultation in a general hospital. This is a cross-sectional study that assessed 237 nursing consultations of patients in two different programs Women's Health (46 in obstetrical nursing and 24 in mastology nursing) and 167 in diabetes mellitus education. A total of 49 nursing diagnoses were identified. The most frequent in the women's health program were: knowledge deficit, impaired comfort, impaired tissue, integrity and anxiety; in the program of diabetes education were: ineffective therapeutic regimen management, and imbalanced nutrition: more than body requirements. There was a significant association between the most common diagnoses with certain demographic and clinical features. The results confirmed that the identification of the nursing diagnoses during the consultation may provide accuracy in the focus of outpatient care.

[Postpartum depression screening scales: a systematic review]. / Escalas de rastreamento para depressão pós-parto: uma revisão sistemática.

This study aims to conduct a systematic review of postpartum depression (PPD) screening scales in puerperal applied until 16 weeks after delivery among women above 15 years old. Articles were searched in 4 databases. The included articles should describe precisely the definition and the validation of the used instruments. Out of the 424 abstracts found, 62 complete articles were accessed and only 18 articles that fulfilled the above-mentioned requirements were included. PPD screening period varied from 2 to 10 days postpartum, and patients were retested between 8 to 16 weeks postpartum. PPD was diagnosed in 8.8 to 40% of the patients sampled in those studies. The most frequent used scale was the Edinburgh Postpartum Depression Scale (EPDS). It was concluded that scales are frequently used in research studies, and may allow the identification of PPD in gestating and puerperal patient care.

A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping.

BACKGROUND: Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. AIMS: A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. METHOD: Subjects were randomized (n=93) into a CBGT group or a CBGT group with MI+TM. RESULTS: When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. CONCLUSIONS: Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial.

OBJECTIVE: Recent factor-analytic studies of obsessive-compulsive disorder identified consistent symptom dimensions. This study was designed in order to observe which obsessive compulsive symptom dimensions could be changed by adding two individual sessions of motivational interviewing and thought mapping of cognitive-behavioral group therapy using a randomized clinical trial. METHOD: Forty outpatients with a primary diagnosis of obsessive-compulsive disorder were randomly assigned to receive cognitive-behavioral group therapy (control group) or motivational interviewing+thought mapping plus cognitive-behavioral group therapy. To evaluate changes in symptom dimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale was administered at baseline and after treatment. RESULTS: At post-treatment, there were statistically significant differences between cognitive-behavioral group therapy and motivational interviewing+thought mapping+cognitive behavioral group therapy groups in the mean total Dimensional Yale-Brown Obsessive-Compulsive Scale score, and in the contamination and aggression dimension score. Hoarding showed a statistical trend towards improvement. CONCLUSION: These findings suggest that adding motivational interviewing+thought mapping to cognitive-behavioral group therapy can facilitate changes and bring about a decrease in the scores in different obsessive-compulsive disorder symptom dimensions, as measured by the Dimensional Yale-Brown Obsessive-Compulsive Scale. Nonetheless, additional trials are needed to confirm these results.

Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder.

OBJECTIVE: To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessive-compulsive disorder (OCD) in outpatient follow-up. METHOD: Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution. RESULTS: Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT. CONCLUSION: The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.

Brief antibullying intervention for adolescents in public schools.

OBJECTIVES: To assess the results of a brief antibullying intervention for adolescents in public schools. METHOD: This was a controlled experimental study whose subjects were 1,043 students in 5th through 9th grades from public schools in Porto Alegre/State of Rio Grande do Sul, conducted between April and November 2015. Adolescents and school teachers randomly assigned to the intervention group participated in two meetings focused on educative aspects of bullying. Outcome was assessed using the Bullying Questionnaire - victim and perpetrator version. Generalized Estimating Equations was used to evaluate the effect of the intervention. RESULTS: Average age of subjects was 12.5 (SD=1.62) years. A total of 613 (58.7%) adolescents participated in interventions. They were compared to 430 (41.3%) participants in the control group. The study did not observe any significant difference in bullying scores after the intervention. CONCLUSIONS: This study indicates the usefulness of clarifying precisely what bullying is in schools as part of an initial approach to an educative strategy on this topic.