Music Distraction Effectiveness in Dental Anxiety and Treatment Adherence in 6-Year-Old Children: A Randomized Clinical Trial / Efectividad de la Distracción Musical Sobre la Ansiedad Dental y Adherencia a Tratamiento en Niños de 6 Años: Ensayo Clínico Aleatorizado

ABSTRACT: Dental anxiety can be a barrier to following healthy behaviours. Musical distraction is an effective strategy to reduce dental anxiety and improve treatment adherence. The aim was to determine the effect of musical distraction on dental anxiety and treatment adherence in 6-year-old children. Multicenter randomized control trial with 176 children who were allocated into two parallel groups. One group received usual dental care (N 88), and the other was exposed to musical distraction during usual dental care (N 88). The primary outcome was dental anxiety and secondary was oral health status and oral health care behaviours. Both were assessed at baseline, discharged and six-month follow-up. Mid/high dental anxiety was exhibited by 16.1 % of the children. Musical distraction had no effect on dental anxiety levels in the experimental compared with the control group at any of the time points assessed. The size effect was 0.35 and 0.15 (Cliff's Delta) for baseline-discharge and 0.57 and 0.35 for baseline-six month. Only 47.7 % of the sample attended at 6-month follow-up. Dental anxiety is not prevalent in the sample and is not beneficially reduced by musical distraction. The educational actions of the dental care programme are not sufficient to attain permanent long-term changes in oral health behaviour.

RESUMEN: La ansiedad dental puede ser una barrera para seguir conductas saludables. La distracción musical es una estrategia efectiva para reducir la ansiedad dental y mejorar la adherencia al tratamiento. El objetivo fue determinar el efecto de la distracción musical sobre la ansiedad dental y la adherencia al tratamiento en niños de 6 años. Ensayo multicéntrico de control aleatorizado con 176 niños asignados a dos grupos paralelos. Un grupo recibió atención dental habitual (n 88) y el otro estuvo expuesto a distracción musical durante el cuidado dental habitual (N 88). El resultado primario fue la ansiedad dental y secundaria fue el estado de salud oral y las conductas de salud oral. Ambos fueron evaluados al inicio, dados de alta y seguidos durante seis meses. La ansiedad dental media / alta fue exhibida por 16,1 % de los niños. La distracción musical no tuvo ningún efecto sobre los niveles de ansiedad dental en el grupo experimental en comparación con el grupo control en ninguno de los momentos evaluados. El efecto del tamaño fue 0,35 y 0,15 (Cliff's Delta) para el inicio y el alta y 0,57 y 0,35 para el inicio y los seis meses de seguimiento. Solo el 47,7 % de la muestra asistió a los 6 meses de seguimiento. La ansiedad dental no prevalece en la muestra y no se ve beneficiada por la distracción musical. Las acciones educativas del programa de atención dental no son suficientes para lograr cambios permanentes a largo plazo en el comportamiento de salud oral.

Efecto de la musicoterapia en el estado de ánimo y calidad de vida de pacientes con cáncer colorrectal / The effectiveness of music therapy on mood and quality of life of colorectal cancer patients

Objetivo: Evaluar la efectividad de un tratamiento de musicoterapia en el estado anímico y calidad de vida de pacientes diagnosticados de cáncer colorrectal (CCR). Método: Dieciocho sujetos (14 mujeres y 4 hombres) diagnosticados de CCR participaron en un tratamiento de ocho sesiones de musicoterapia de grupo, de frecuencia semanal y 90 minutos/sesión. Se administró la Escala de Ansiedad y Depresión Hospitalaria (HAD), el Perfil de Estados de Ánimo - versión reducida A (POMS-A) así como la Escala de Calidad de Vida Global y Escalas de Funcionamiento del Cuestionario de Calidad de Vida de la EORTCQLQ-30 (European Organization for Research and Treatment of Cancer-Quality of Life Core Questionnaire-30) en pre- y post-tratamiento. Se midió el nivel de Ansiedad, Tristeza y Malestar Físico mediante una Escala de Valoración Numérica (EVN) en pre- y post-sesión. Se utilizó una Hoja de Observación y Registro de Conductas (instrumento propio elaborado ad hoc) para registrar las respuestas de cada participante en cada sesión y un Cuestionario de Valoración del Programa de Musicoterapia (instrumento propio, elaborado ad hoc) al finalizar el programa. Resultados: No se han obtenido cambios estadísticamente significativos en el POMS-A, HAD ni EORTC QLQ-C30, si bien todas las puntuaciones obtenidas van en la dirección de cambio deseado. Se ha obtenido una disminución estadísticamente significativa de los niveles de EVN Global de Ansiedad, Tristeza y Malestar. El Cuestionario de Valoración recoge una percepción de alto grado de utilidad y satisfacción por parte de los participantes

Aim: To evaluate the effectiveness of a music therapy treatment on mood and quality of life of colorectal cancer patients. Method: Eighteen subjects (14 women and 4 men) who were diagnosed with colorectal cancer participated in a music therapy program consisting of eight weekly group music therapy sessions, 90 minute-session. Participants completed the following instruments before and after the intervention (pre/post): the Hospital Anxiety and Depression Scale (HADS), the Profile of Mood States-Short Form A (POMS-A), the Global Quality of Life Scale and the Functioning Scales of the European Organization for Research and Treatment of Cancer-Quality of Life Core QuestionnaireC30 (EORTC-QLQ-C30). A 3 item Numerical Rating Scale (NRS) for Anxiety, Sadness and Physical Distress was administered at the beginning and end of each session (pre/post session). An Observation Behavior Form (designed ad hoc) was used to evaluate mood after each session. A Music Therapy Program Satisfaction Questionnaire (designed ad hoc) was administered at the end of the program. Results: Although all the obtained scores pointed to a desirable change direction, non significant changes were found in the POMS-A, HADS nor EORTC QLQ-C30. A significant improvement was found in the Anxiety, Sadness and Physical Distress NRS items. The Music. Therapy Program Satisfaction Questionnaire showed that participants perceived this type of intervention as very useful and very satisfactory

Análisis Rasch de la versión española de la escala Mindful Attention Awareness Scale en una muestra clínica / Rasch Analysis of the Spanish version of the Mindful Attention Awareness Scale (MAAS) in a clinical sample

Introducción. El uso clínico del mindfulness ha aumentado en los últimos años, y la Mindful Attention Awareness Scale (MAAS) se ha convertido en uno de los instrumentos más empleados para su medida. El objetivo de esta investigación fue analizar la eficacia del entrenamiento en mindfulness y las propiedades psicométricas de las puntuaciones de la MAAS en una muestra clínica mediante el modelo de Rasch. Métodos. Se seleccionaron 199 sujetos con sintomatología ansioso-depresiva. El grupo experimental (n = 103) recibió un entrenamiento grupal en mindfulness y el grupo control (n = 96) un tratamiento ambulatorio convencional con la misma duración. Se analizaron las puntuaciones pre y pos en la MAAS para valorar la eficacia del entrenamiento, las propiedades psicométricas de las puntuaciones y el funcionamiento diferencial de los ítems (DIF) usando el Modelo de Escalas de Calificación (MEC). Resultados. Los ítems 9 y 12 desajustaron, el ítem 9 mostró DIF, y se observaron problemas de traducción al castellano en los ítems 5, 9 y 12. Se decide repetir el análisis eliminándolos. Los resultados de la versión reducida MAAS-12 mostraron valores adecuados en dimensionalidad, ajuste y fiabilidad. Conclusiones. Contrariamente a los resultados de otros trabajos, la MAAS fue sensible al cambio producido por el entrenamiento. La versión habitualmente empleada presenta problemas métricos y de traducción y debe revisarse. La escala MAAS-12 es métricamente mejor que la habitualmente empleada, pero adolece de infrarrepresentación del constructo. Se recomienda construir instrumentos desde una perspectiva teórica coherente, de modo que todas las facetas del atributo se vean representadas (AU)

Introduction. The clinical use of mindfulness has increased recently, and the Mindful Attention Awareness Scale (MAAS) has become one of the most used tools to measure it. The aim of this study was to test the effectiveness of mindfulness training and analyzing the psychometric properties of the MAAS scores in a clinical sample using the Rasch Model. Methods. One hundred and ninety-nine participants with mood-anxiety clinical symptoms were recruited. The experimental group (n = 103) received mindfulness training, and the control group (n = 96) a conventional outpatient treatment for the same duration. The pre-post MAAS scores were analyzed to test the effectiveness of training, the psychometric properties of the scores, and differential item functioning (DIF) using the Rating Scale Model (RSM). Results. Misfit in items 9 and 12, DIF in item 9, and Spanish translation problems in the items 5, 9 and 12 were observed. The repetition of the analysis without these items was decided. Appropriate dimensionality, fit and reliability values were obtained with the short version, MAAS-12. Conclusions. Contrary to previous studies, the MAAS was sensitive to treatment-associated change. However, the commonly used MAAS has some translation and metric problems, and should be revised. MAAS-12 is a better scale than MAAS but suffers from construct under-representation. Constructing tools from a coherent theoretical perspective is suggested, so that all mindfulness facets are represented (AU)

Estrategias de relajación durante el período de gestación: beneficios para la salud / Relaxation strategies during pregnancy. Health benefits

La práctica de la relajación puede ser una estrategia efectiva de afrontamiento del estrés propio de la gestación, una etapa de cambios tanto físicos como emocionales que requiere adaptaciones rápidas. El objetivo de este trabajo ha sido evaluar los efectos de la práctica regular de una técnica de relajación en mujeres gestantes sobre variables emocionales y físicas: estrés, ansiedad, depresión, tasa cardíaca (TC) y presión arterial (PA). La muestra ha estado compuesta por 46 mujeres gestantes con edades comprendidas entre los 18 y 38 años, residentes en Portugal. La muestra se ha dividido en dos grupos, experimental y control, el primero de los cuales recibió entre el 2o y el 8o mes de gestación un total de veinte-veinticinco sesiones individuales de relajación progresiva y visualización. Se evalúa la eficacia de la intervención con medidas pre y postratamiento de TC y PA, así como de ansiedad, depresión y estrés con las escalas de Ansiedade, Depressão e Stresse-EADS-21. Los datos encontrados evidencian la eficacia de la práctica de la relajación en las medidas evaluadas (AU)

The practice of relaxation may be an effective strategy for coping with stress during the pregnancy period, a stage of physical and emotional changes that requires adaptations. The objective was to evaluate the effects of the regular practice of a relaxation technique in pregnant women on emotional and physical variables: stress, anxiety, depression, heart rate (HR), and blood pressure (BP). Sample: 46 pregnant women, aged between 18 and 38 years, and living in Portugal. Method: These women were divided into two groups, experimental and control. The experimental group received, between the 2nd and the 8th month of pregnancy a total of twenty to twenty five individual sessions of visualization and progressive relaxation. To evaluate the effectiveness of the intervention, HR and BP was measured pre- and posttreatment, as well as anxiety, depression, and stress, using EADS-21. The results demonstrate the effectiveness of the intervention on the variables assessed (AU)

[Anxiety levels and quality of life assessment in patients that underwent an electrophysiologic study due to unexplained palpitations]. / Açiklanamayan çarpinti nedeniyle elektrofizyolojik çalisma yapilan hastalarda yasam kalitesi ve kaygi düzeylerinin degerlendirilmesi.

OBJECTIVES: To compare the quality of life and anxiety levels of patients with normal and abnormal results detected during an electrophysiological study (EPS) that was performed due to undocumented palpitations. STUDY DESIGN: Patients (n=128) who underwent EPS without documented arrhythmia of unexplained palpitations were included in the study. The quality of life and anxiety levels of patients with abnormal EPS results were compared with those with normal results by using the 26-item short form of the World Health Organization quality of life scale and state-trait anxiety inventory. RESULTS: SVT was found in 72 patients by diagnostic EPS. Quality of life scores were significantly poorer in the SVT group than of the normal EPS group (p=0.000-0.001). Likewise, the anxiety scores of the patients in the SVT group were higher than normal in the EPS group (p=0.000). Age, physical quality of life, psychological quality of life, state anxiety and trait anxiety were found to be independent predictors of SVT in multivariate regression analysis. CONCLUSION: The level of anxiety was found to be higher and quality of life was found to be lower in patients with palpitations due to SVT. In clinical practice it should be kept in mind that noticed psychiatric symptoms may be secondary to an underlying arrhythmia in the evaluation of patients with palpitations.

Estudio cuasi-experimental sobre las terapias de relajación en pacientes con ansiedad / Quasi-experimental relaxation therapies in patients with anxiety

Introducción: Los trastornos de ansiedad son muy frecuentes en atención primaria y especializada. Para reducir la ansiedad se recomienda el uso de terapias de relajación como terapia alternativa a la psicofarmacología. El objetivo del estudio será averiguar si las terapias de relajación benefician a los pacientes con ansiedad. Material y métodos: Se utilizó metodología cuantitativa: estudio cuasi-experimental de antes y después, longitudinal, prospectivo. Sujetos a estudio: pacientes diagnosticados de ansiedad y que acepten participar en la terapia de relajación en el centro de salud mental Infante (Murcia), desde diciembre hasta marzo de 2010. (n=39). Variable independiente: terapia de relajación; variable dependiente: ansiedad. Otras variables: sexo, edad, nivel educativo y tratamiento con psicofármacos. Se utiliza la escala validada: STAI; se comparan puntuaciones pre-post-intervención (se aplica t de student, xi cuadrado (intervalo de confianza p< 0'05). Resultados: Realizan el test STAI pre-post 39 pacientes, 69% mujeres y 31% hombres. La edad media: 39'84 años. Un 77% tomaban medicación y el 23% no. Predominaba claramente el de educación secundaria obligatoria (ESO). La media de ansiedad estado antes fue de 68 y después de 56. STAI estado (antes/después) con un nivel de significación de p< 0'027, por lo que se aceptó la hipótesis nula. Se observó que en los pacientes que no tomaban psicofármacos, el descenso de ansiedad era significativo con una p<0'036. Conclusiones: Los talleres de técnicas de relajación son útiles en la reducción de la ansiedad en atención especializada, además son más eficaces en pacientes con ansiedad que no tomen medicación (AU)

Introduction: Anxiety disorders are highly prevalent in primary and specialty care. To reduce anxiety the use of relaxation therapy is recommended as an alternative therapy to Psychopharmacology. The aim of the study is determine whether relaxation therapies benefit patients with anxiety. Materials and Methods: We used quantitative methodology: a quasi-experimental study before and after a, longitudinal, prospective study. Subjects studied: patients diagnosed with anxiety who agreed to participate in relaxation therapy at the mental health center Infante (Murcia), from December 2009 to March 2010. (N = 39). Independent variable was relaxation therapy and the dependent variable was anxiety. Other variables were sex, age, educational level and treatment with psychotropic drugs. Validated scale used was STAI, scores comparing pre-post-intervention (t student applies, xi square confidence interval (p <0.05). Results: The test was performed by pre-post STAI 39 patients, 69% female and 31% male. The mean age was 39'84 years. 77% were taking medication and 23% were not. There was a clearly dominance of secondary education (ESO). Mean state anxiety before was 68 and after 56. STAI state (before / after) with a significance level of p <0'027, so the null hypothesis was accepted. It was observed that in patients not taking psychotropic drugs, the decrease in anxiety was significant at p <0'036. Conclusions: Workshops in relaxation techniques are helpful in reducing anxiety in specialized care, and are more effective in patients with anxiety who do not take medication (AU)

[The effects of visual imagery on adjustment and quality in life of hemodialysis patients]. / Görsel Imgelemenin Hemodiyaliz Hastalarinin Uyum ve Yasam Kalitesine Etkisi.

OBJECTIVE: Relaxation and imagery techniques have been widely used among patients with chronic physical illnesses other than end stage renal failure (ESRF). Case studies and some controlled studies suggest that relaxation and imagery techniques can be successfully used with hemodialysis patients to improve their adjustment. Nonetheless, randomized controlled studies are needed to systematically examine this effect. METHOD: The present study examined the effect of a specific visual imagery technique on adjustment and quality of life in a sample of 153 hemodialysis patients. Control procedures included an active control and a no-treatment control. The former consisted of relaxation training and general imagery techniques. Outcome variables included beliefs about hemodialysis treatment, ways of evaluating life, emotional adjustment, and quality of life. The ESRF Beliefs Questionnaire, the Life Evaluation Questionnaire for Hemodialysis Patients, the Hospital Anxiety and Depression Scale, the Ladder Scale, and 2 SF-36 summary scales were used to measure these outcome variables. RESULTS: The findings show that the specific imagery intervention did not have an effect on emotional adjustment or quality of life, either post-treatment or at follow-up; however, the rate of patient compliance with the interventions was moderately high and patients reported that they were satisfied with the intervention procedures. CONCLUSION: The present study is the first randomized controlled intervention study of the effects of relaxation and imagery on adjustment in hemodialysis patients. The findings are discussed in terms of their implications for future studies as well as their limitations.

Efficacy of wrists overnight compression (HT 7 point) on insomniacs: possible role of melatonin?

AIM: Insomnia is a major problem which decreases life quality. Many causes are involved with it and anxiety is often associated. The underlying mechanism is not completely understood, even though different factors seem to be associated. Among them melatonin and its circadian rhythm is thought to have an important role. In addition, acupressure and acupuncture are known to ameliorate insomnia and anxiety, when a specific wrist point is stimulated (HT 7 Shenmen). With these bases, the aim of the present study has been to evaluate the efficacy of an acupressure device, ''H7-insomnia control'', positioned on HT 7 points, during the night, in terms of general health and anxiety levels, together with the evaluation of sleep quality and the urinary melatonin metabolite 6-hydroxymelatonin sulphate determination, in a number of insomniacs. METHODS: Forty patients with insomnia were divided into two groups and randomly received either the H7 or placebo treatments, in a double-blind protocol, for 20 nights. Before and after treatments every subject answered a series of questionnaires (General Health Questionnaire 28 items; State-Trait Anxiety Inventory; Pittsburgh Sleep Quality Index) and collected 24 h urines, divided into two samples of 12 h each. Urinary melatonin metabolite was then determined using a RIA method. RESULTS: Data obtained indicate that the device H7-insomnia control is efficacious to ameliorate quality of sleep and reduce anxiety levels in insomniacs, at a higher extent than in the placebo group. In addition, the 24 hours urinary melatonin metabolite rhythm, obtained at the end of treatment, was considered as being normal in a higher percentage of H7-treated patients, with respect to the placebo group. CONCLUSION: It is plausible to hypothesize that the wrist acupressure device might be considered a valid tool, without adverse effects since it does not contain pharmaceutical products, that is able to naturally ameliorate sleep quality in insomniacs, acting through a not jet completely clarified mechanism, that may involve melatonin.

Conscious surgery: influence of the environment on patient anxiety.

AIMS: This paper is a report of a study: (i) to investigate anxiety arising from the experience of the clinical environment during surgery under local/regional anaesthesia and (ii) to uncover the specific aspects patients find anxiety provoking and possibly dissuade them from opting for such anaesthesia. BACKGROUND: Operating theatre staff have focused historically on conducting safe, efficient surgery with unconscious patients and not primarily on the care of 'awake' patients. However, with the rise in day surgery, the volume of surgery performed under local or regional anaesthesia is increasing. METHOD: As part of a larger study investigating anxiety in elective day surgery, a questionnaire was given to 523 patients on the day of surgery to adult patients undergoing surgery with local or regional anaesthesia between 2005 and 2007. They were asked to return this by mail 24-48 hours following surgery and 214 completed questionnaires were returned (response rate 41%). FINDINGS: The experience of being awake, possibly feeling the surgeon's touch, seeing their body cut open or surgery being more painful than expected were anxiety-provoking aspects. Using factor analysis, 'intra-operative apprehension', 'anaesthetic information provision' and 'health control' were identified as central features. Multiple regression showed that apprehension associated with the intra-operative experience and anaesthetic information provision were statistically significantly associated with an increase in overall level of anxiety. CONCLUSION: Focusing care on managing the intra-operative experience and providing anaesthetic information in advance might help limit anxiety and expel the apparent misapprehensions associated with conscious surgery.

Anxiety sensitivity, body vigilance and fear of pain.

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed.

Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial.

BACKGROUND: Dental anxiety is a significant cause of poor dental health. Because patients often prefer nonpharmacological interventions, the clinical effectiveness of clearly structured approaches is of particular interest. METHODS: This prospective randomized controlled study compares a brief relaxation method (BR) with music distraction (MD) and with a control group (C). The authors randomly assigned 90 patients with dental anxiety to BR, MD or C groups. They assessed the outcomes by means of the state anxiety subscale of the State-Trait Anxiety Inventory. RESULTS: Both BR and MD reduced dental anxiety significantly. In contrast, patients in the C group did not exhibit a significant change in their anxiety level. BR was significantly superior to MD. Stratification according to the patient's general level of dental anxiety revealed that BR also was particularly effective in highly anxious subjects, whereas MD did not have a clinically relevant effect on these subjects. CONCLUSIONS: BR appears to be a safe, economically sound and effective nonpharmacological approach to the short-term reduction of dental anxiety. Additional investigations are needed to validate these findings in a larger clinical trial and to determine the long-term effects of this intervention. CLINICAL IMPLICATIONS: Relaxation techniques are a pragmatic, effective and cost-saving method of facilitating dental treatment in anxious patients.

Hypnotizability, absorption and negative cognitions as predictors of dental anxiety: two pilot studies.

BACKGROUND: The authors conducted two pilot studies that investigated the roles of hypnotizability, absorption (defined as the ability to maintain focused attention on a task or stimulus) and state versus trait anxiety as predictors of dental anxiety. One of the studies also examined the effectiveness of hypnosis in managing dental anxiety. METHODS: Participants in study 1 completed measures of hypnotizability and anxiety, viewed a video of a dental procedure either under hypnosis or not, and completed dental anxiety questionnaires. Participants in study 2 were told either that the video showed major dental work or a routine polishing. All subjects watched the video and then completed measures assessing their perceptions of the video and their anxiety. RESULTS: The authors found a positive relationship between hypnotizability and scores on the Dental Anxiety Scale (DAS) (F(1,290) = 3.45, P = .06), as well as an interaction between hypnotizability and hypnosis (F(1,290) = 6.55, P = .01). An analysis of covariance found a relationship between trait and dental anxiety (F(1,290) = 11.50; P = .001). A two-way analysis of variance found a main effect for hypnosis (F(1,290) = 3.20, P = .07). The authors found an effect for group on the DAS (F(1,228) = 3.67, P = .057), such that subjects in the negative-cognition group scored higher on the DAS. The authors found an interaction between absorption and cognition in perceptions of pain experienced by the patient in the video (F(1,228) = 3.70, P = .05) and in ratings of one's own pain level if in the same situation (F(1,228) = 4.38, P < .05). CONCLUSIONS: Hypnotizability or absorption, pre-existing anxiety and cognitions about dental procedures predict dental anxiety, and hypnosis may be helpful for some, but not all, patients. CLINICAL IMPLICATIONS: Characteristics such as hypnotizability, trait anxiety and negative cognitions predict which people develop dental anxiety and who will be more responsive to hypnosis. The authors provide suggestions for dentists treating anxious patients.

Rapid relaxation--practical management of preoperative anxiety.

Rapid relaxation (RR) is a brief set of suggestions, given while applying topical anesthetic, to reduce anxiety during local anesthesia and subsequent dental treatment. RR is recommended for managing mild dental anxiety, which is almost universal. RR combines elements of hypnosis, meditation and good basic chairside manner. It is noninvasive, takes little additional time, and empowers patients by providing them with an attractive, immediate alternative to catastrophization. We have found that RR markedly improves the quality of the dental experience.

Intervención grupal en los trastornos de ansiedad en Atención Primaria: técnicas de relajación y cognitivo-conductuales / Group intervention in anxiety disorders in Primary Health Care: relaxation and cognitive-behavioral techniques

INTRODUCCIÓN. Los trastornos de ansiedad son muy frecuentes en Atención Primaria. Su tratamiento incluye técnicas de relajación y respiración controlada y técnicas cognitivo-conductuales. Nuestro objetivo es valorar la eficacia del aprendizaje grupal de las técnicas mencionadas para reducir la ansiedad. MÉTODOS. El diseño es descriptivo longitudinal pre-post-intervención. Sujetos de estudio: pacientes que realizan los talleres de técnicas de relajación (18 grupos) en el centro de salud de octubre de 1997 a junio de 2004 (con asistencia al 80% de sesiones) (n = 117). Intervención: taller de 8 sesiones en 2 meses que incluye entrenamiento en respiración, técnicas de relajación (de Jacobson y entrenamiento autógeno de Schultz) y técnicas cognitivas (afrontamiento de estrés, resolución de problemas). Participan 10-12 personas por sesión semanal. Variables: sexo, edad, motivo para realizar el taller, tratamiento con psicofármacos. Se realiza escala de ansiedad-depresión de Goldberg (EADG)-18 ítems, antes y tras los talleres; se comparan puntuaciones pre-post-intervención (prueba de la t, intervalo de confianza al 95%). RESULTADOS. Realizan la EADG pre-post-intervención 95 pacientes, de los que el 93,7% son mujeres. La edad media es 46,8 años (desviación estándar 12,6). Los principales motivos para realizar el taller son: ansiedad el 51,6%, síntomas somáticos el 10,5% y el 9,5% son cuidadoras. El 47,4% toman tratamiento psicofarmacológico, sin diferencias en las puntuaciones de la EADG pre y post-intervención respecto al grupo sin tratamiento. El descenso medio de ansiedad pre-post-intervención en la EADG es de 3,2 puntos (2,7-3,6) (p < 0,0001) y de 1,9 (1,59-2,28) (p < 0,0001) en la subescala de depresión. CONCLUSIONES. Los talleres de técnicas de relajación pueden ser útiles en la reducción de la ansiedad y la depresión en Atención Primaria

INTRODUCTION. Anxiety disorders are very frequent in Primary Health Care. Relaxation and controlled respiration techniques and cognitive-behavior techniques are included in its treatment. METHODS. The design is pre-post intervention longitudinal and descriptive. Study subjects: patients who did a relaxation technique workshop (18 groups) in the health care center from October 1997 to June 2004 (with attendance to 80% of the sessions) (n = 117). Intervention: workshop of 8 sessions in 2 months includes training in breathing, relaxation techniques (of Jacobson and autogenous training of Schultz) and cognitive techniques (confronting stress, problem solving). Ten to 12 persons participate per weekly session. Variables: gender, age, reason for doing the workshop, treatment with psychodrugs. Goldberg Anxiety-Depression Scale (GADS)-18 items was applied before and after the workshops. Pre-post intervention scores (T test, 95% confidence interval) were compared. RESULTS. Pre-post intervention GADS was done in 95 patients, 93.7% of whom were woman. Mean age was 46.8 years (standard deviation 12.6). The main reasons for taking the workshop were: anxiety 51.6%, somatic symptoms 10.5% and 9.5% are caretakers. A total of 47.4% were taking psychodrug treatment, without differences in the pre-post-intervention GADS scores regarding the group without treatment. The mean decrease in pre-post intervention anxiety in the GADS was 3.2 points (2.79-3.6) (p < 0.0001) and 1 (1.59-2.28) (p < 0.0001) on the depression subscale. CONCLUSIONS. Relaxation technique workshops may be useful in the reduction of anxiety and depression in Primary Health Care

[Comparison of the psychological effects of standard exercises with those of space exercises in autogenic training: from the perspective of passive concentration].

The purpose of this study was to compare the psychological effects of the heaviness and the warmth Standard Exercises (SE) with those of the first Space Exercises (SP) in Autogenic Training (AT) on college students. This study was conducted by the repeated practice of two experimental groups (SE, SP) and one control group (CT). The participants in the experimental groups practiced once a week, for three weeks. All the participants were assessed with State-Trait Anxiety Inventory-Trait Anxiety (STAI-T), Autogenic Training Clinical Effectiveness Scale (ATCES), and Rosenberg's Self-Esteem Scale. The results showed that the SE group showed more decreases in STAI-T and more increases in ATCES than the SP group, while the more neurotic, showed more increases in self-esteem in both the SE and SP groups. It is possible that non-clinical adults with high neuroticism might be able to enhance their STAI-T and ATCES in the SE group than in the SP group if their SE trainers respected their bodily abilities in readily responding to changes in sensations.

A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management.

OBJECTIVE: The aim of the present study was to determine the validity of subjective anxiety assessment and the outcomes of management of children receiving operative dental treatment. SETTING: The study was conducted at the Departments of Sedation and Child Dental Health, Newcastle Dental Hospital, Newcastle upon Tyne, UK. SUBJECTS AND METHODS: One hundred children and adolescents aged between 8 and 15 years participated in the study. Clinicians subjectively allocated 50 children for treatment with local analgesia alone (low anxiety), and identified 50 children who had the potential to benefit from nitrous oxide and oxygen sedation (high anxiety). Participants then completed the State-Trait Anxiety Inventory for Children (STAIC), the Venham Picture Test (VPT) and the Child Fear Survey Schedule-Dental Subscale (CFSS-DS). A global rating scale classified behaviour during dental treatment. RESULTS: State anxiety and dental fear prior to treatment were significantly higher in children allocated to receive inhalation sedation (P = 0.004 and P = 0.005, respectively). There was no significant difference in trait anxiety or post-treatment state anxiety between the two groups (P = 0.69 and P = 0.06, respectively). Only 11% displayed 'negative' behaviour during treatment: 82% of this group represented those allocated to receive sedation. CONCLUSION: Children receiving inhalation sedation were significantly more anxious prior to treatment than children receiving treatment with local analgesia alone. The findings support the subjective assessment of anxiety in children; however, objective anxiety measures may assist clinicians in identifying specific fears, which may ultimately aid patient management.

Relaxation techniques for reducing pain and anxiety during screening mammography.

OBJECTIVE: The purpose of this study was to determine whether listening to a relaxation audiotape before and during mammography decreases subjective reports of pain and anxiety. CONCLUSION: Listening to a relaxation or music audiotape before and during mammography does not reduce subjective reports of anxiety or pain. Women undergoing screening mammography report minimal levels of distress.

Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients' experiences of well-being after surgery.

BACKGROUND: The primary aims were to compare the pain-relieving effect and post-operative well-being between electro-acupuncture analgesia (EA) and conventional analgesia (CA) comprising opiates. Further aims were to compare time for mobilization, and costs for time and drug consumption. METHODS: In all, 160 women undergoing IVF were randomized, according to a computer-generated list, to EA or CA. Well-being was evaluated with the State Trait Anxiety Inventory (STAI). Pain and subjective expectations and experiences were recorded on a visual analogue scale (VAS). Time and drug consumption were recorded. RESULTS: Although VAS pain ratings were significantly higher at oocyte aspiration (P < 0.0001) and after retrieval (P < 0.01) in the EA than in the CA group, they were similar 60 min after surgery. Both groups had similar STAI well-being scores. The EA group was significantly less tired and confused than the CA group after oocyte aspiration. No significant differences in time and costs for drug consumption were noted. CONCLUSION: EA cannot generally be recommended as a pain-relieving method at oocyte aspiration but might be an alternative for women desiring a non-pharmacological method. An advantage of EA is less post-operative tiredness and confusion compared with CA.

Willingness to pay for dental fear treatment. Is supplying dental fear treatment socially beneficial?

The aim of this paper is to discuss the social desirability of supplying dental fear treatment in addition to dental treatment using the results from a treatment programme for patients with severe dental fear. The programme consisted of three different dental fear treatments: Cognitive therapy, applied relaxation and nitrous oxide sedation, in addition to dental treatment. To evaluate the effects of uncertainty on the patients' benefits from the programme, we elicited their willingness to pay, both before and after receiving treatment, since we expected patients to be uncertain about the outcome of the dental fear treatment. We found that the social desirability of the treatment was very sensitive to uncertainty. While only 24% of the patients were willing to pay the actual cost of the treatment before attending, 71% were willing to pay afterwards. This implies that many patients who would benefit from the treatment ex post are not willing to pay the cost of the treatment ex ante, and will thus not receive any treatment unless it is subsidized.

Efficacy of the herbal medicine Unkei-to as an adjunctive treatment to hormone replacement therapy for postmenopausal women with depressive symptoms.

OBJECTIVE: Although hormone replacement therapy (HRT) improves menopausal depressive symptoms, women unresponsive to HRT need an antidepressant drug as an effective adjunctive therapy. The aim of this study was to assess whether the herbal medicine Unkei-to has an impact on HRT-resistant menopausal depressive symptoms as an effective adjunctive therapy combined with HRT. METHODS: Twenty-four HRT-resistant menopausal depressive women were randomly assigned to group 1 (n = 12) or group 2 (n = 12). Subjects in group 1 were accessioned into 6 months of open treatment with Unkei-to as an adjunctive therapy and changed to Toki-shakuyaku-san for 6 months following a 1-month washout period. Group 2 started with Toki-shakuyaku-san for 6 months and then changed to Unkei-to for 6 months following a 1-month washout period. RESULTS: Three months' treatment with Unkei-to as an adjunctive therapy significantly improved Zung's Self-Rating Depression Scale (ZSDS) scores, State-Anxiety (STAI-1) scores, and Trait-Anxiety (STAI-2) scores noted before treatment, and this effect continued at 6 months. Treatment with Unkei-to was also significantly effective in reduction of ZSDS scores, STAI-1 scores, and STAI-2 scores at 3 months compared with Toki-shakuyaku-san treatment, and this effect continued at 6 months. CONCLUSIONS: Unkei-to is another option as an adjunctive herbal therapy in HRT-resistant menopausal depressive women.