Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia.

BACKGROUND: Little is known about psychological well-being in remitted patients with panic disorder and agoraphobia and its interactions with residual symptoms. METHODS: Thirty patients with panic disorder and agoraphobia who displayed a successful response to exposure therapy, and 30 control subject matched for sociodemographic variables, were administered both observer-rated and self-rated scales for assessing residual symptoms and well-being. RESULTS: Patients had significantly more residual symptoms -- as assessed by the Clinical Interview for Depression (CID) and the Symptom Questionnaire (SQ) -- than controls. They also had significantly less environmental mastery, personal growth, purpose in life and self-acceptance -- as measured by the Psychological Well-being Scales (PWB) -- and less SQ physical well-being than controls. LIMITATION: The findings apply to patients with panic disorders who had been treated by behavioral methods and may be different in drug-treated subjects. CONCLUSIONS: The results indicate that successful reduction of symptomatology in panic disorder cannot be equated to a pervasive recovery (encompassing psychological well-being) and may pave the way for sequential therapeutic strategies of more enduring quality.

Explanatory therapy in hypochondriasis.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of individual explanatory therapy in hypochondriasis. METHOD: Twenty patients with DSM-IV hypochondriasis were randomly assigned to 2 groups. One received explanatory therapy and was assessed again after a 6-month follow-up. The other was first assigned to a waiting list and subsequently treated with explanatory therapy. All patients received usual medical care from their physicians. Assessments involved both observer and self-rated instruments. RESULTS: In both groups, explanatory therapy was significantly associated with a reduction of hypochondriacal fears and beliefs, improvement in affective disturbances and anxiety sensitivity, and a decrease in health care utilization. Therapeutic gains were maintained at follow-up. Substantial residual symptomatology, however, remained. CONCLUSION: The results suggest that hypochondriasis is a treatable condition and that explanatory therapy is a viable therapeutic tool. Further research should disclose the actual components of the mechanism of change in hypochondriacal patients.

Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders.

BACKGROUND: There is increasing awareness of the prognostic value of residual symptomatology in affective disorders and of the need for specific therapeutic strategies in this phase of illness. The aims of the study were to apply a novel, short-term psychotherapeutic approach for increasing well-being, based on Ryff's conceptual model, to remitted patients with affective disorders and to compare the results with those obtained with symptom-oriented cognitive behavioural strategies. METHODS: Twenty patients with affective disorders (major depression, panic disorder with agoraphobia, social phobia, generalized anxiety disorder, obsessive-compulsive disorder) who had been successfully treated by behavioural or pharmacological methods were randomly assigned to a well-being enhancing therapeutic strategy (well-being therapy) or cognitive-behavioural treatment of residual symptoms. RESULTS: Both well-being and cognitive-behavioural therapies were associated with a significant reduction of residual symptoms. However, a significant advantage of well-being therapy over cognitive-behavioural strategies was observed with observer-rated methods. DISCUSSION: These preliminary results suggest the feasibility of well-being therapy in the residual stage of affective disorders. Further research should determine its value as a relapse-preventive strategy in specific mood and anxiety disorders.