[An integrative and transdiagnostic relaxation protocol for anxious patients. Results of a pilot study]. / Protocole de relaxation intégrative et transdiagnostique pour patients anxieux. Résultats d'une étude pilote.

INTRODUCTION: The literature data show that relaxation practice is effective in reducing anxiety symptoms. Different techniques such as progressive muscular relaxation, autogenic training, applied relaxation and meditation have been evaluated independently for anxiety disorders. The question is to know whether the combination of various techniques may be of interest in the transdiagnostic treatment of anxiety disorders. AIM OF THE STUDY: The present study assessed the short-term efficacy of a 10-week integrative and transdiagnostic relaxation program for anxiety disorders in outpatients of an anxiety disorders unit. METHODS: The diagnoses were made according to the Mini-International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) and completed with an assessment of anxiety and depressive symptoms using: the State Trait Anxiety Inventory (STAI-Y, -S and -T), the Penn State Worry Questionnaire (PSWQ) and the Beck Depression Inventory (BDI-II). Four techniques were integrated into the structured 10-week protocol: breathing control, muscular relaxation, meditation and mental visualization. RESULTS: Twenty-eight patients (12 men and 16 women), mean age (S.D.)=38.82 years (11.57), were included in the study. All the included patients fulfilled the DSM-IV criteria for a current diagnosis of Generalized Anxiety Disorder (n=13) or Panic Disorder (n=15) with or without agoraphobia. At the end of the 10 sessions, we found a significant reduction in mean scores (S.D.) on the STAI-T from 53.179 (6.037) to 49.821 (8.028) (P<0.02), the BDI-II 20.964 (13.167) to 15.429 (11.341) (d=0.6543) and the QIPS 55.071 (10.677) to 49.679 (11.7) (d=0.5938). The observed reduction in the STAI-S (d=0.2776) was not significant. DISCUSSION: The results of this open study showed that this program significantly decreases the level of trait anxiety, depression and worry. The integrative and transdiagnostic relaxation program could represent an accessible and effective treatment to reduce anxious and depressive symptoms in various anxiety disorders. Future research should address the development of controlled trials assessing the impact of the different dimensions of anxiety and the long-term effects of this protocol.

The perception of fearful and happy facial expression is modulated by anxiety: an event-related potential study.

Anxiety is supposed to interfere with cognitive and emotional processing and high level of trait-anxiety has been associated with an attentional bias for fearful faces, even in sub-clinical anxiety. On the basis of the Spielberger State and Trait Anxiety Inventory (STAI), twenty students were grouped as low vs. high anxious. Pictures from the Ekman and Friesen series were used in an event-related potentials study to investigate the neurophysiological correlates of the emotional processing of fear and happiness in sub-clinical anxiety. Subjects were confronted with a visual oddball design, in which they had to detect, as quickly as possible, deviant happy or fearful faces amongst a train of standard stimuli (neutral faces). Anxiety does not modify early perceptual (N100, P100, N170, VPP) or attentional (N2b) component, but later components are affected. Indeed, high anxious subjects are faster to detect deviant faces as suggested by earlier reaction times and P3b component. However, they show a reduced ability to process the emotional content of faces, this deficit being indexed by a decreased N300 component. Indeed, N300 is supposed to be particularly sensitive to affective features of stimuli rather than to physical characteristics. We propose that the earlier P3b observed in high anxious subjects could be interpreted as a way to overcome the deficient emotional appraisal by a more salient conscious processing.