Moderators of short- and long-term outcomes in panic control treatment and panic-focused psychodynamic psychotherapy.

OBJECTIVE: The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). METHOD: Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up. RESULTS: Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term. CONCLUSIONS: These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

Effects of panic-specific cognitive behavioural and psychodynamic psychotherapies on work ability in a doubly randomised clinical trial.

Objective: The effects of panic-specific psychotherapy on occupational functioning remain under-researched. This study tests whether two brief psychotherapies for Panic Disorder with or without Agoraphobia (PD/A) may generate improvement in work ability. Methods: Adults (N = 221) with a primary diagnosis of PD/A were randomised to wait-list, panic-focused psychodynamic psychotherapy (PFPP), panic control treatment (PCT), or to the choice between the two treatments. Participants completed the Work Ability Inventory (WAI) at baseline, post-treatment, and during 24-month follow-ups. Change in WAI scores were assessed using segmented multilevel linear growth models, and mediation was explored through path analysis. Results: WAI scores changed from the moderate to good range between baseline and post-treatment (SMD = 0.45; 95% CI [0.33, 0.57]) and continued to increase throughout the follow-up (SMD = 0.16; 95% CI [0.03, 0.28]) with no differences between treatments or allocation forms. In PFPP (but not in PCT) pre- to post-treatment change in WAI was mediated by reduction in panic symptoms and WAI predicted employment status and absences. Conclusions: Two brief panic specific psychotherapies, one cognitive behavioural and one psychodynamic, produced short and long-term increases in work ability.

Host ecology regulates interspecies recombination in bacteria of the genus Campylobacter.

Horizontal gene transfer (HGT) can allow traits that have evolved in one bacterial species to transfer to another. This has potential to rapidly promote new adaptive trajectories such as zoonotic transfer or antimicrobial resistance. However, for this to occur requires gaps to align in barriers to recombination within a given time frame. Chief among these barriers is the physical separation of species with distinct ecologies in separate niches. Within the genus Campylobacter, there are species with divergent ecologies, from rarely isolated single-host specialists to multihost generalist species that are among the most common global causes of human bacterial gastroenteritis. Here, by characterizing these contrasting ecologies, we can quantify HGT among sympatric and allopatric species in natural populations. Analyzing recipient and donor population ancestry among genomes from 30 Campylobacter species, we show that cohabitation in the same host can lead to a six-fold increase in HGT between species. This accounts for up to 30% of all SNPs within a given species and identifies highly recombinogenic genes with functions including host adaptation and antimicrobial resistance. As described in some animal and plant species, ecological factors are a major evolutionary force for speciation in bacteria and changes to the host landscape can promote partial convergence of distinct species through HGT.

Condition Monitoring of Railway Crossing Geometry via Measured and Simulated Track Responses.

This paper presents methods for continuous condition monitoring of railway switches and crossings (S&C, turnout) via sleeper-mounted accelerometers at the crossing transition. The methods are developed from concurrently measured sleeper accelerations and scanned crossing geometries from six in situ crossing panels. These measurements combined with a multi-body simulation (MBS) model with a structural track model and implemented scanned crossing geometries are used to derive the link between the crossing geometry condition and the resulting track excitation. From this analysis, a crossing condition indicator Cλ1-λ2, Î³ is proposed. The indicator is defined as the root mean square (RMS) of a track response signal γ that has been band-passed between frequencies corresponding to track deformation wavelength bounds of λ1 and λ2 for the vehicle passing speed (f = v/ λ). In this way, the indicator ignores the quasi-static track response with wavelengths predominantly above λ1 and targets the dynamic track response caused by the kinematic wheel-crossing interaction governed by the crossing geometry. For the studied crossing panels, the indicator C1-0.2 m, Î³ (λ1=1 and λ2=0.2) was evaluated for γ = u, v, or a as in displacements, velocities, and accelerations, respectively. It is shown that this condition indicator has a strong correlation with vertical wheel-rail contact forces that is sustained for various track conditions. Further, model calibrations were performed to measured sleeper displacements for the six investigated crossing panels. The calibrated models show (1) a good agreement between measured and simulated sleeper displacements for the lower frequency quasi-static track response and (2) improved agreement for the dynamic track response at higher frequencies. The calibration also improved the agreement between measurements and simulation for the crossing condition indicator demonstrating the value of model calibration for condition monitoring purposes.

A numerical study on the safety belt-to-pelvis interaction.

The slide of the lap belt over the iliac crest of the pelvis during vehicle frontal crashes can substantially increase the risk of some occupant injuries. A multitude of factors, related to occupants or the design of belt, are associated with this phenomenon. This study investigates safety belt-to-pelvis interaction and identifies the most influential parameters. It also explores how initial lap belt position influences the interaction between lap belt and pelvis. A finite element model of the interaction between lap belt with pelvis through a soft tissue part was created. Belt angle, belt force, belt loading rate and belt-to-body friction as belt design parameters, and pelvis angle, constitute parameters of soft tissue, and soft tissue-to-pelvis friction as occupant parameters were inspected. For the soft tissue part, subcutaneous adipose tissue with different thicknesses was created and the effect initial lap belt position may have on lap belt-to-pelvis interaction was investigated. The influential parameters have been identified as: the belt angle and belt force as belt design parameters and the pelvis angle and compressibility of soft tissue as occupant parameters. The risk for the slide of lap belt over the iliac crest of the pelvis was predicted higher as the initial lap belt positions goes superior to the pelvis. Of different submarining parameters, the lap belt angle represents the most influential one. The lap belt-to-pelvis interaction is influenced by the thickness of subcutaneous adipose tissue between lap belt and pelvis indicating a higher risk for obese occupants.

Exploring termination setback in a psychodynamic therapy for panic disorder.

OBJECTIVE: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during the treatment to determine whether such setbacks are in fact common in PDT. METHOD: In a doubly randomized clinical preference trial, 217 adults, female = 163; M age = 34.8 (12.6), with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment (Weeks 1-12), and 6, 12, and 24 months after treatment. Using piecewise latent growth curve modeling, we tested the trajectories of change focusing on the termination phase in PFPP. RESULTS: Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during Weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to Week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up. CONCLUSIONS: This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Habitus and climate change: Exploring support and resistance to sustainable welfare and social-ecological transformations in Sweden.

We explore peoples' dispositions and practices with regard to social-ecological transformations based on a sustainable welfare policy strategy in Sweden. We draw on Bourdieu's concept of habitus to highlight the relations between social positions, dispositions, and position-takings. Using data from an own survey, we identify habitus types and place these in the space of social positions. We apply principal component analysis to a large set of questions about social, ecological, and climate change related topics and identify eight underlying eco-social dispositions. These are used for cluster analyses that find typical constellations of eco-social dispositions within the Swedish population: variants of eco-social habitus. We find seven habitus types and describe their social characteristics, political preferences, and practices. Finally, the seven habitus are plotted onto the map of social positions, the Bourdieusian social space, highlighting their relations-proximities, tensions, and contestations-to each other. We find evidence that political struggles around social-ecological transformations reproduce existing social structures but are also connected to new "eco-social" divisions that appear between groups in similar positions. In the conclusion we discuss the implications for social-ecological transformations based on sustainable welfare.

Preferences for panic control treatment and panic focused psychodynamic psychotherapy for panic disorder - who chooses which and why?

Objective: Few studies have examined factors associated with patient's choice of particular psychological treatments. The present study explores possible associations to, and the reasons given for, patient's choice of Panic Control Treatment (PCT) or Panic-Focused Psychodynamic Psychotherapy (PFPP) for Panic Disorder with or without Agoraphobia (PD/A).Method: Both quantitative and qualitative analyses were applied to data obtained from 109 adults with PD/A who were randomized to the Choice condition in the doubly randomized controlled preference trial from which this data are drawn.Results: The strongest associations were between treatment credibility ratings and the treatment choice (d = -1.00 and 1.31, p < .01, for PCT and PFPP respectively). Treatment choice was also moderately associated with patient characteristics, treatment helpfulness beliefs, and learning style. Qualitative analysis revealed that patients gave contrasting reasons for their treatment choice; either a focus on the present, symptom reduction and problem-solving for those who chose PCT or a focus on the past, symptom understanding and reflection for those who chose PFPP.Conclusions: When offered a choice between two evidence-based psychotherapies for PD/A, the resulting choice was primarily a function of the patient's beliefs about the chosen therapy, its potential for success, and their preferred learning style.

The Effect of Patient's Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial.

INTRODUCTION: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. OBJECTIVE: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. METHODS: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. RESULTS: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, -0.64; 95% confidence interval, CI, -1.02 to -0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27-0.98). There was no allocation by treatment type interaction (SMD -0.57; 95% CI -1.31 to 0.17). CONCLUSIONS: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.

Psychometric analysis of the Swedish panic disorder severity scale and its self-report version.

BACKGROUND: Panic disorder, with or without agoraphobia (PDA or PD, respectively), is a major public health problem. After having established a PD diagnosis based on the DSM or the ICD systems, the Panic Disorder Severity Scale (PDSS) is the most widely used interview-based instrument for assessing disorder severity. There is also a self-report version of the instrument (PDSS-SR); both exist in a Swedish translation but their psychometric properties remain untested. METHODS: We studied 221 patients with PD/PDA recruited to a randomized controlled preference trial of cognitive-behavioral and brief panic-focused psychodynamic psychotherapy. In addition to PDSS and PDSS-SR the participants completed self-reports including the Clinical Outcome in Routine Evaluation - Outcome Measure, Montgomery Åsberg Depression Rating Scale, Sheehan Disability Scale, Bodily Sensations Questionnaire and the Mobility Inventory for Agoraphobia. RESULTS: PDSS and PDSS-SR possessed excellent psychometric properties (internal consistency, test-retest reliability) and convergent validity. A single factor structure for both versions was not confirmed. In terms of clinical utility, the PDSS had very high inter-rater reliability and correspondence with PD assessed via structured diagnostic interview. Both versions were sensitive to the effects of PD-focused treatment, although subjects scored systematically lower on the self-report version. CONCLUSIONS: The study confirmed the reliability and validity of the Swedish versions of PDSS and PDSS-SR. Both versions were highly sensitive to the effects of two PD-focused treatments and can be used both in clinical and research settings. However, further investigation of the factor structures of both the PDSS and PDSS-SR is warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01606592.

Characterization of Campylobacter spp. isolated from wild birds in the Antarctic and Sub-Antarctic.

A lack of knowledge of naturally occurring pathogens is limiting our ability to use the Antarctic to study the impact human-mediated introduction of infectious microorganisms have on this relatively uncontaminated environment. As no large-scale coordinated effort to remedy this lack of knowledge has taken place, we rely on smaller targeted efforts to both study present microorganisms and monitor the environment for introductions. In one such effort, we isolated Campylobacter species from fecal samples collected from wild birds in the Antarctic Peninsula and the sub-Antarctic island of South Georgia. Indeed, in South Georgia, we found Campylobacter lari and the closely related Campylobacter peloridis, but also distantly related human-associated multilocus sequence types of Campylobacter jejuni. In contrast, in the Antarctic Peninsula, we found C. lari and two closely related species, Campylobacter subantarcticus and Campylobacter volucris, but no signs of human introduction. In fact, our finding of human-associated sequence types of C. jejuni in South Georgia, but not in the Antarctic Peninsula, suggests that efforts to limit the spread of infectious microorganisms to the Antarctic have so far been successful in preventing the introduction of C. jejuni. However, we do not know how it came to South Georgia and whether the same mode of introduction could spread it from there to the Antarctic Peninsula.

A Priori Assessment of Adipose Tissue Mechanical Testing by Global Sensitivity Analysis.

In modeling the mechanical behavior of soft tissues, the proper choice of an experiment for identifying material parameters is not an easy task. In this study, a finite element computational framework is used to virtually simulate and assess commonly used experimental setups: rotational rheometer tests, confined- and unconfined-compression tests, and indentation tests. Variance-based global sensitivity analysis is employed to identify which parameters in different experimental setups govern model prediction and are thus more likely to be determined through parameter identification processes. Therefore, a priori assessment of experimental setups provides a base for systematic and reliable parameter identification. It is found that in indentation tests and unconfined-compression tests, incompressibility of soft tissues (adipose tissue in this study) plays an important role at high strain rates. That means bulk stiffness constitutes the main part of the mechanism of tissue response; thus, these experimental setups may not be appropriate for identifying shear stiffness. Also, identified material parameters through loading-unloading shear tests at a certain rate might not be reliable for other rates, since adipose tissue shows highly strain rate dependent behavior. Frequency sweep tests at a wide-enough frequency range seem to be the best setup to capture the strain rate behavior. Moreover, analyzing the sensitivity of model parameters in the different experimental setups provides further insight about the model itself.

A Nonlinear Viscoelastic Model for Adipose Tissue Representing Tissue Response at a Wide Range of Strain Rates and High Strain Levels.

Finite element human body models (FEHBMs) are nowadays commonly used to simulate pre- and in-crash occupant response in order to develop advanced safety systems. In this study, a biofidelic model for adipose tissue is developed for this application. It is a nonlinear viscoelastic model based on the Reese et al.'s formulation. The model is formulated in a large strain framework and applied for finite element (FE) simulation of two types of experiments: rheological experiments and ramped-displacement experiments. The adipose tissue behavior in both experiments is represented well by this model. It indicates the capability of the model to be used in large deformation and wide range of strain rates for application in human body models.

The POSE study - panic control treatment versus panic-focused psychodynamic psychotherapy under randomized and self-selection conditions: study protocol for a randomized controlled trial.

BACKGROUND: Panic disorder with or without agoraphobia is a commonly occurring disorder affecting 2 to 3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioral approaches are the recommended first-line treatment for panic disorder; however, many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials comparing the 'gold standard' treatment for panic disorder to other evidence-based psychotherapies are needed, and also trials that can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer term. METHODS/DESIGN: A phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18 to 70 years) with a primary diagnosis of DSM-IV Panic Disorder (with or without Agoraphobia). Within each clinic, patients are randomized to self-selection, random assignment of treatment, or wait-list. Patients choose or are randomly assigned to either Panic Control Treatment or Panic-Focused Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at post-treatment and 6, 12 and 24 months post-treatment. Secondary outcomes include changes in agoraphobic avoidance, psychiatric comorbidity, disability, and healthcare utilization. The study also employs elements of an effectiveness trial as therapist and service-related effects on outcome will be estimated. Putative change mechanisms for the two treatments are also assessed. DISCUSSION: Cognitive behavioral and psychodynamic therapies are both evidence-based approaches that are routinely offered to panic disordered patients in Sweden. However, little is known about the relative effectiveness of these two approaches for panic/agoraphobia, work-related disability and healthcare utilization over the longer term. The current trial (POSE) also addresses the important but understudied issue of whether patient preference for a particular psychotherapeutic approach moderates outcome. TRIAL REGISTRATION: ClinicalTrials.gov NCT01606592 (registered 19 March 2012).

A case of depressive personality disorder: aligning theory, practice, and clinical research.

Depressive personality disorder (DPD) is highly studied and common in clinical settings. Nevertheless, it is rife with controversies and often overshadowed by major depression and dysthymia with which it shares many similarities but also is clinically distinct. Possibly as a result, DPD is underdiagnosed and misunderstood in clinical care. Thus the goal of this practice review is to present a case from psychiatric clinical work illustrating how DPD may be commonly overlooked in routine care, and how the conceptualization of this case and its treatment plan changed course once DPD was considered by treating staff, ultimately contributing to the successful outcome of the case. Questions elicited by the case are subsequently discussed in the context of the empirical literature on DPD, allowing for a clearer picture to emerge on DPD and its role in the development, course, and treatment of depression.

The psychosocial atmosphere in community-based activity centers for people with psychiatric disabilities: visitor and staff perceptions.

This study investigated how visitors and staff in community-based activity centers in Sweden perceived the psychosocial atmosphere and whether this could be explained by the centers' orientation (work-oriented versus meeting place-oriented centers). Eighty-eight visitors and 37 staff members at three work-oriented and three meeting place-oriented centers participated. The Community-oriented Programs Environmental Scale was used to estimate the psychosocial atmosphere. The result showed that the psychosocial atmosphere at the centers was in accordance with a supportive ward atmosphere profile. Visitors and staff perceived several aspects of the psychosocial atmosphere differently, especially in the meeting place-oriented centers. The visitors in the meeting place-oriented centers did not perceive the psychosocial atmosphere differently from those visiting the work-oriented centers. The results indicated that the psychosocial atmosphere at the centers was in line with what previous research has shown to be beneficial for visitors regarding outcome and favorable for promoting a good therapeutic alliance and a good functioning in daily life.

Simulation of active skeletal muscle tissue with a transversely isotropic viscohyperelastic continuum material model.

Human body models with biofidelic kinematics in vehicle pre-crash and crash simulations require a constitutive model of muscle tissue with both passive and active properties. Therefore, a transversely isotropic viscohyperelastic continuum material model with element-local fiber definition and activation capability is suggested for use with explicit finite element codes. Simulations of experiments with New Zealand rabbit's tibialis anterior muscle at three different strain rates were performed. Three different active force-length relations were used, where a robust performance of the material model was observed. The results were compared with the experimental data and the simulation results from a previous study, where the muscle tissue was modeled with a combination of discrete and continuum elements. The proposed material model compared favorably, and integrating the active properties of the muscle into a continuum material model opens for applications with complex muscle geometries.

Reading times and adaptive styles among patients diagnosed with psychosis as assessed by the Serial Color-Word Test.

The present study focuses on how patients diagnosed with psychosis deal with a conflicting situation. In the study, two groups of patients were assessed. One group consisted of patients diagnosed with psychosis (n = 41), while the comparison group (n = 135) consisted of inpatients diagnosed either with anorexia nervosa or with bulimia nervosa. The groups were assessed using the Serial Color Word Test (S-CWT), designed for studying an individual's successive adaptation over time to a conflicting situation. The S-CWT differentiated the two groups regarding both reading time and adaptive styles. Patients diagnosed with psychosis had longer reading times and an adaptive style that was deviant throughout the test, indicating poorer cognitive functioning and more serious psychopathology. These problems may in turn influence functioning in work or study and daily living, all of which are important in treatment planning.

Therapeutic alliance and outcome in routine psychiatric out-patient treatment: patient factors and outcome.

OBJECTIVE: This study investigated the importance of the therapeutic alliance in a routine psychiatric out-patient unit regarding treatment outcome and the influence of patient factors. DESIGN: The study had a naturalistic and longitudinal design where the treatments the patient received were determined by the normal routines at the unit and were performed by a variety of staff representative of a psychiatric out-patient unit. METHOD: Newly admitted patients were diagnosed according to the International Classification of Diseases-10th Revision and completed questionnaires regarding the therapeutic alliance, symptoms, and interpersonal problems at the beginning and termination of their treatment (N=76). The time limit for the termination assessments was set at 18 months. RESULTS: The therapeutic alliance at the beginning of treatment did not correlate with outcome, however, at the end of the treatment the alliance significantly explained about 15% of the variance of the outcome (global severity index). An improvement of the alliance during the treatment significantly correlated with most of the outcome variables. The relation of the alliance to outcome was equal among the different diagnosis groups and treatment forms. CONCLUSION: The results showed that the therapeutic alliance is an important variable for treatment outcome in routine psychiatric treatment, and improving the therapeutic alliance may be one of the most important factors for increasing the total effectiveness of a treatment unit.