Self-help cognitive-behavioral therapy with minimal therapist contact for social phobia: a controlled trial.

Due to treatment accessibility and cost issues, interest in self-help programs (e.g., bibliotherapy, telehealth) for common psychological disorders is growing. Research supporting the efficacy of such a program for social anxiety, however, is limited. The present study examined the efficacy of an 8-week self-directed cognitive behavioral treatment with minimal therapist involvement for social phobia based on a widely available self-help book. Twenty-one adults with social phobia initially received either treatment (i.e. assigned readings in the workbook with limited therapist contact) or were wait-listed. Wait-listed patients eventually received the same self-directed treatment. Results revealed that the self-help/minimal therapist contact treatment was superior to wait-list on most outcome measures. Across the entire sample, reductions in social anxiety, global severity, general anxiety, and depression were observed at posttest and 3-month follow-up. These findings provide preliminary support for using this self-help workbook for individuals with mild to moderate social anxiety in conjunction with infrequent therapist visits to reinforce the treatment principles. Study limitations and future directions are discussed.

A controlled pharmacogenetic trial of sibutramine on weight loss and body composition in obese or overweight adults.

BACKGROUND & AIMS: Weight loss in response to sibutramine is highly variable. We assessed the association of specific markers of polymorphisms of candidate alpha2A adrenoreceptor, 5-HT transporter, and GNbeta3 genes and weight loss with sibutramine. METHODS: We conducted a randomized, double-blind, pharmacogenetic study of behavioral therapy and sibutramine (10 or 15 mg daily) or placebo for 12 weeks in 181 overweight or obese participants. We measured body weight, body mass index, body composition, gastric emptying, and genetic variation (alpha2A C1291G, 5-HTTLPR, and GNbeta3 C825T genotypes). Analysis of covariance was used to assess treatment effects on and associations of the specific markers of candidate genes with weight loss and body composition. RESULTS: Sibutramine, 10 and 15 mg, caused weight loss (P = .009); there was a statistically significant gene by dose interaction for GNbeta3 genotype. For each candidate gene, significant treatment effects at 12 weeks were observed (P < .017) for all specific genotype variants (Delta weight loss in the 2 sibutramine doses vs placebo): alpha2A CC (Delta, approximately 5 kg), GNbeta3 TC/TT (Delta, approximately 6 kg), and 5-HTTLPR LS/SS (Delta, approximately 4.5 kg). Gene pairs resulted in significantly greater sibutramine treatment effects on weight (both P < .002): in participants with 5-HTTLPR LS/SS with GNbeta3 TC/TT; Delta, approximately 6 kg and those with alpha2A CC with GNbeta3 TC/TT; Delta, approximately 8 kg; however, effects were not synergistic. Treatment with sibutramine also resulted in significantly greater reduction of body fat for specific alpha2A CC and GNbeta3 TC/TT genotype variants individually (both P < .02). CONCLUSIONS: Patient selection based on candidate genes may enhance response to multidimensional sibutramine and behavioral therapy for obesity.

Listening to hypochondriasis and hearing health anxiety.

Although hypochondriasis is categorized as a somatoform disorder in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition--Text Revision (DSM-IV-TR) due to excessive focus on bodily symptoms for at least 6 months, a contemporary conceptualization suggests that hypochondriasis represents an intense form of health anxiety. This article discusses the clinical presentation of hypochondriasis, etiological underpinnings and multiple maintaining factors, including physiological, cognitive and behavioral components. A cognitive-behavioral model of hypochondriasis as health anxiety and the empirically supported treatment based on the model are articulated. Future directions and informational resources are provided for both clinicians and patients.

Hypochondriasis: conceptualization, treatment, and relationship to obsessive-compulsive disorder.

Once considered exclusively as a problem secondary to other mental dis-orders (ie, mood disorders), HC is now known to occur quite often as a pri-mary diagnosis. A frequent drain on medical resources, patients who have HC can be viewed as suffering essentially from an anxiety disorder in which intense fear is focused on the possibility that they might be seriously physically ill or that such illness is imminent. The processes that contribute to the development and maintenance of such health anxiety consist largely of beliefs, assumptions, and behavioral responses that, although internally consistent with the perception of health-related threat, are erroneous and highly maladaptive in that they prevent the correction of erroneous perceptions of threat. There is growing evidence that this conceptualization leads to effective reduction in HC symptoms through cognitive-behavioral and pharmacologic treatments. By far the main obstacle to successful treatment of HC is the patient's reluctance to view the problem as anything other than physical. The authors have found, however, that patients appreciate their care providers showing a genuine understanding of their concerns and taking the time to offer a logical, coherent explanation and rationale for the need for psychological and psychiatric services.