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1.
Adv Exp Med Biol ; 1191: 237-261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002933

RESUMO

Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Doença Crônica , Comorbidade , Humanos , Transtorno de Pânico/complicações , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia
2.
Adv Exp Med Biol ; 1191: 465-485, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002942

RESUMO

In almost all treatments for prevalent psychiatric conditions, particular attention has been devoted to stress and its consequences; this has led to an involuntary and unavoidable reinforcement of negative aspects of life. Because of the important influence of individual and cultural influences on positive health, well-being is a challenge from a clinical and scientific perspective and interventions aimed at enhancing it represent an area of growing interest for the future of clinical practice and research. Well-being therapy (WBT) is a short-term psychotherapeutic strategy aimed at enhancing well-being based on the model originally developed in 1958 by Marie Jahoda. It emphasizes self-observation, with the use of a structured diary, interaction between patients and therapists, and homework. WBT may be used as the only therapeutic strategy or in sequential combination with other psychotherapeutic strategies, mainly cognitive behavioral therapy. WBT can be differentiated from positive interventions based on several features which are described in detail in the present chapter. We also report the clinical use of WBT in the treatment of anxiety disorders, mainly generalized anxiety disorder, panic disorder, and agoraphobia. Potential further clinical application of WBT is withdrawal after antidepressants discontinuation and side effects during long-term antidepressant treatment.


Assuntos
Transtornos de Ansiedade/terapia , Psicoterapia , Agorafobia/terapia , Antidepressivos/efeitos adversos , Terapia Cognitivo-Comportamental , Humanos , Transtorno de Pânico/terapia
3.
Nord J Psychiatry ; 73(7): 417-424, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31373520

RESUMO

Aims: The current study explore the relationship between the trajectories of primary panic disorder symptoms and secondary depressive symptoms during guided internet-delivered cognitive behaviour therapy for panic disorder. Materials and methods: The patients (N=143) were recruited from an ongoing effectiveness study in secondary mental health outpatient services in Norway. Weekly self-reported primary panic disorder symptoms and secondary depressive symptoms were analysed. Results: primary panic disorder symptoms and secondary depressive symptoms improved significantly during the course of treatment, and at six months follow-up. Parallel process latent growth curve modelling showed that the trajectory of depressive symptoms and trajectory of panic disorder symptoms were significantly related. A supplementary analysis with cross-lagged panel modelling showed that (1) pre-treatment depressive symptoms predicted a positive effect of panic disorder symptoms early in treatment; (2) high early treatment panic disorder symptoms predicted low depressive symptoms at post-treatment. Conclusions: Guided ICBT for panic disorder is effective for both primary panic disorder symptoms and secondary depressive symptoms. Patients with high pre-treatment secondary depressive symptoms may constitute a vulnerable subgroup. A high level of panic disorder symptoms early in treatment seems beneficiary for depressive symptoms outcome. A time-dependent model may be necessary to describe the relationship between PAD symptoms and depressive symptoms during the course of treatment.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Depressão/terapia , Internet , Transtorno de Pânico/terapia , Autorrelato , Terapia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Serviços Comunitários de Saúde Mental/métodos , Depressão/epidemiologia , Depressão/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Resultado do Tratamento , Adulto Jovem
4.
BMC Psychol ; 7(1): 53, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31439043

RESUMO

BACKGROUND: Clinical anxiety is common during the perinatal period, and anxiety symptoms often persist after childbirth. Ten to 30 % of perinatal women are diagnosed with panic disorder (PD)-far more than the 1.5-3% rate among the general population. Although cognitive behavioral therapy (CBT) has been determined to be an effective treatment for PD, few studies have been conducted on CBT effectiveness in treating postpartum PD and, to the best of the knowledge of the present authors, no research has been conducted on postpartum PD among Japanese women. In this manuscript, we report on our administration of CBT to three postpartum patients with PD, detailing the improvement in their symptoms. CASE PRESENTATION: All patients in this study were married, in their thirties, and diagnosed using the Mini-International Neuropsychiatric Interview as having PD with agoraphobia. The Panic Disorder Severity Scale (PDSS) was used to evaluate patients' panic symptoms and their severity. All patients received a total of 16 weekly 50-min sessions of CBT, and all completed the treatment. All patients were exceedingly preoccupied with the perception that a "mother must protect her child," which reinforced the fear that "the continuation of their perinatal symptoms would prevent them from rearing their children". After treatment, all participants' panic symptoms were found to have decreased according to the PDSS, and two no longer met clinical criteria: Chihiro's score changed from 13 to 3, Beth's PDSS score at baseline from 22 to 6, and Tammy's score changed from 7 to 1. CONCLUSIONS: CBT provides a therapeutic effect and is a feasible method for treating postpartum PD. It is important that therapists prescribe tasks that patients can perform collaboratively with their children.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno de Pânico/terapia , Período Pós-Parto , Adulto , Agorafobia/complicações , Agorafobia/terapia , Ansiedade/psicologia , Ansiedade/terapia , Feminino , Humanos , Transtorno de Pânico/etiologia , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
5.
Z Evid Fortbild Qual Gesundhwes ; 143: 15-20, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31176641

RESUMO

INTRODUCTION: For the treatment of anxiety disorders behavior therapy-oriented methods are recommended for primary care as well. Within the trial "Jena-PARADISE" a primary care practice team-supported exposure training for patients with panic disorder with or without agoraphobia was developed and evaluated. The present paper gives an overview of general practitioners' subjective views on the practicability, feasibility and effectiveness of this new intervention for both patients and GP teams. METHODS: Questions were operationalized based on Bellg's intervention fidelity framework. Fourteen GPs of the intervention group were sampled purposefully and interviewed in a semi-structured way. Generated data were analyzed following Mayring's content analysis approach. RESULTS: The treatment program was positively assessed among the GPs and seen as a useful therapeutic option for inadequately treated patients. The therapy elements 'psycho-education' and 'interoceptive exposure exercises' were described as feasible, while situational exercises and relapse prevention got a less positive rating. The active participation of the nurse in the treatment program was seen as supportive. CONCLUSION: From the GP perspective, the treatment program for patients with panic disorder and/or agoraphobia seems to be a viable therapeutic option in primary care.


Assuntos
Agorafobia/terapia , Terapia Comportamental , Medicina Geral , Clínicos Gerais , Transtorno de Pânico/terapia , Alemanha , Humanos , Resultado do Tratamento
6.
Nord J Psychiatry ; 73(4-5): 293-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31157577

RESUMO

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.


Assuntos
Transtornos de Ansiedade/psicologia , Emoções/fisiologia , Metacognição/fisiologia , Transtorno de Pânico/psicologia , Inquéritos e Questionários , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/terapia
7.
Behav Cogn Psychother ; 47(6): 645-658, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31122300

RESUMO

BACKGROUND: Research has long investigated the cognitive processes in the treatment of depression, and more recently in panic disorder (PD). Meanwhile, other studies have examined patients' cognitive therapy skills in depression to gain insight into the link between acquiring such skills and treatment outcome. AIMS: Given that no scale exists to examine in-session patient use of panic-related cognitive behavioural therapy (CBT) skills, the aim of this study was to develop a new measure for assessing patients' cognitive and behavioural skills in CBT for PD. METHOD: This study included 20 PD patients who received 12 weekly individual therapy sessions. The Cognitive Behavioral Therapy Panic Skills (CBTPS) rating system was developed. Three independent raters coded tapes of therapy sessions at the beginning and end of treatment. RESULTS: The coefficient alphas and inter-rater reliability were high for the cognitive and behavioural subscales. Improvement in the patients' CBTPS scores on both subscales indicated overall symptom improvement, above improvement in anxiety sensitivity. CONCLUSION: To our knowledge, this is the first study examining the impact of patient acquisition of CBT PD skills on treatment outcome. A new measure was developed based on the observations and was deemed reliable and valid. The measure facilitates the examination of the mechanisms of change in treatment for PD. An in-depth examination of the CBTPS may refine our understanding of the impact of each skill on PD treatment outcome. Further research relating to acquiring CBT skills could shed light on the mechanisms of change in treatment.


Assuntos
Terapia Cognitivo-Comportamental , Educação em Saúde , Transtorno de Pânico/terapia , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia , Reprodutibilidade dos Testes , Resultado do Tratamento , Adulto Jovem
8.
Behav Ther ; 50(3): 659-671, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31030881

RESUMO

Emotion regulation (ER) has been incorporated into many models of psychopathology, but it has not been examined directly in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/A). In this study, a preliminary model of ER in CBT for PD/A is proposed based on existing theories, and several propositions of the model are tested. We hypothesized that increases in cognitive reappraisal would precede decreases in biased cognitions, decreases in expressive suppression would follow decreases in biased cognitions, and a reduction in symptom severity would follow decreases in expressive suppression. Twenty-nine patients who received CBT for PD/A completed weekly self-report measures of symptom severity, anxiety sensitivity, reappraisal and expressive suppression. In addition, patients were compared to a matched normal sample. Cross-lagged analyses partially supported the hypotheses. Reappraisal did not change until late stages of therapy and was generally not associated with treatment outcome. Suppression decreased significantly and exhibited a reciprocal relationship with biased cognitions. Symptom reduction followed decreases in suppression as hypothesized. However, patients did not differ in ER from matched controls at either pre- or posttreatment. Results suggest the important distinction between reappraisal and appraisal, and stress the role of session-by-session decreases in suppression as a predictor of symptom reduction.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Emoções/fisiologia , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Adulto , Agorafobia/diagnóstico , Agorafobia/psicologia , Agorafobia/terapia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Autorrelato , Resultado do Tratamento
9.
Behav Cogn Psychother ; 47(5): 611-615, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30935431

RESUMO

BACKGROUND: Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist. AIMS: The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment. METHOD: Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment. RESULTS: The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans' knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction. CONCLUSIONS: In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Adulto , Feminino , Humanos , Masculino , Psicometria , Estudos Retrospectivos , Autoeficácia , Resultado do Tratamento , Veteranos/psicologia
10.
Neuropsychobiology ; 78(1): 31-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947222

RESUMO

Panic disorder (PD) is associated with increased body vigilance and reduced cognitive resources directed at non-fear-related stimuli, particularly in the absence of stimulus-rich environments. To date, only few studies have investigated whether this deficit in PD is reflected in reduced mismatch negativity (MMN), an event-related potential indexing preattentive sensitivity to unexpected stimulus changes. We tested 35 patients affected by PD and 42 matched healthy controls in an oddball paradigm, using frequency and duration deviant stimuli to measure auditory MMN. PD patients displayed reduced duration MMN amplitudes in comparison to healthy controls. No group differences were detected for duration MMN latency, as well as frequency MMN indices. Results support the notion of reduced processing of non-fear-related stimuli in PD patients, particularly with regard to the preattentive processing of sound duration deviants. Additionally, our findings are in line with clinical studies reporting divergent deficits in preattentive processing of frequency and duration deviants.


Assuntos
Atenção , Percepção Auditiva , Transtorno de Pânico/psicologia , Adulto , Atenção/fisiologia , Percepção Auditiva/fisiologia , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Masculino , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia
11.
Transl Psychiatry ; 9(1): 75, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30718541

RESUMO

Preclinical studies point to a pivotal role of the orexin 1 (OX1) receptor in arousal and fear learning and therefore suggest the HCRTR1 gene as a prime candidate in panic disorder (PD) with/without agoraphobia (AG), PD/AG treatment response, and PD/AG-related intermediate phenotypes. Here, a multilevel approach was applied to test the non-synonymous HCRTR1 C/T Ile408Val gene variant (rs2271933) for association with PD/AG in two independent case-control samples (total n = 613 cases, 1839 healthy subjects), as an outcome predictor of a six-weeks exposure-based cognitive behavioral therapy (CBT) in PD/AG patients (n = 189), as well as with respect to agoraphobic cognitions (ACQ) (n = 483 patients, n = 2382 healthy subjects), fMRI alerting network activation in healthy subjects (n = 94), and a behavioral avoidance task in PD/AG pre- and post-CBT (n = 271). The HCRTR1 rs2271933 T allele was associated with PD/AG in both samples independently, and in their meta-analysis (p = 4.2 × 10-7), particularly in the female subsample (p = 9.8 × 10-9). T allele carriers displayed a significantly poorer CBT outcome (e.g., Hamilton anxiety rating scale: p = 7.5 × 10-4). The T allele count was linked to higher ACQ sores in PD/AG and healthy subjects, decreased inferior frontal gyrus and increased locus coeruleus activation in the alerting network. Finally, the T allele count was associated with increased pre-CBT exposure avoidance and autonomic arousal as well as decreased post-CBT improvement. In sum, the present results provide converging evidence for an involvement of HCRTR1 gene variation in the etiology of PD/AG and PD/AG-related traits as well as treatment response to CBT, supporting future therapeutic approaches targeting the orexin-related arousal system.


Assuntos
Agorafobia , Aprendizagem da Esquiva/fisiologia , Cérebro/fisiopatologia , Terapia Cognitivo-Comportamental , Medo/fisiologia , Receptores de Orexina/genética , Transtorno de Pânico , Adulto , Agorafobia/genética , Agorafobia/fisiopatologia , Agorafobia/terapia , Estudos de Casos e Controles , Cérebro/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/genética , Transtorno de Pânico/fisiopatologia , Transtorno de Pânico/terapia , Fenótipo , Adulto Jovem
12.
J Nerv Ment Dis ; 207(3): 184-187, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30724830

RESUMO

High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects. A randomized controlled clinical trial is needed to verify our findings.


Assuntos
Agorafobia/terapia , Terapia por Exercício/métodos , Treinamento Intervalado de Alta Intensidade/métodos , Transtorno de Pânico/terapia , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento
13.
Clin Psychol Psychother ; 26(4): 399-408, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30811709

RESUMO

This study aimed to investigate whether two theoretically derived moderators of treatment, degree of worry and avoidance at pretreatment, moderated anxiety from pretreatment to post-treatment in a randomized controlled trial comparing metacognitive therapy and cognitive behavioural therapy. Personality problems, degree of co-morbidity, and demographic characteristics (work status and education) were also investigated. Seventy-four patients with a primary diagnosis of post-traumatic stress disorder, social phobia, or panic disorder with and without agoraphobia were analysed using multilevel modelling. There were no significant predictors of treatment outcome, indicating that the slope was not dependent on worry, avoidance, personality problems, degree of co-morbidity, and demographic characteristics. Furthermore, no interaction with treatment condition was found. Due to the sample size, the results of the moderator analysis should be interpreted with caution and replicated. Worry, avoidance, personality problems, degree of co-morbidity, and demographic variables did not moderate the effect of metacognitive therapy and cognitive behavioural therapy or predict treatment outcome for co-morbid anxiety disorders. Clinical implications are discussed.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Metacognição , Transtornos de Estresse Pós-Traumáticos/complicações , Adulto , Agorafobia/complicações , Agorafobia/psicologia , Agorafobia/terapia , Transtornos de Ansiedade/psicologia , Escolaridade , Emprego , Feminino , Humanos , Masculino , Noruega , Transtorno de Pânico/complicações , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Fobia Social/complicações , Fobia Social/psicologia , Fobia Social/terapia , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Resultado do Tratamento
14.
Nervenarzt ; 90(7): 715-723, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30715554

RESUMO

BACKGROUND: Virtual reality (VR) has been investigated as a medium for exposure therapy of anxiety disorders for 20 years. Various meta-analyses have provided convincing evidence of the therapeutic efficacy of exposure therapy in VR. OBJECTIVE: In recent years VR technology and its applications have considerably improved. Therefore, the current state of the art of VR exposure therapy is presented. MATERIAL AND METHODS: This article provides a narrative review of current research on VR exposure therapy for anxiety disorders and major directions of development in this area. RESULTS: After an almost exclusive focus on specific phobias in the early days, research on more complex anxiety disorders (particularly on social anxiety disorder) is increasing. In addition, VR has become established as an experimental method to probe psychopathological processes and to elucidate the mechanism of action of (VR) exposure therapy. CONCLUSION: There is still a need for more research into VR exposure therapy, especially in complex anxiety disorders (e. g. panic disorder, agoraphobia and social anxiety disorder) and trauma-related disorders. Furthermore, VR has become established as a research tool. The rapid technological development gives reason to expect a continuing increase in VR research, in clinical as well as basic research.


Assuntos
Transtornos de Ansiedade , Terapia de Exposição à Realidade Virtual , Transtornos de Ansiedade/terapia , Humanos , Transtorno de Pânico/terapia , Transtornos Fóbicos/terapia , Terapia de Exposição à Realidade Virtual/normas , Terapia de Exposição à Realidade Virtual/tendências
15.
Nord J Psychiatry ; 73(1): 58-63, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30636466

RESUMO

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.


Assuntos
Transtorno de Pânico/classificação , Escalas de Graduação Psiquiátrica , Psicometria , Índice de Gravidade de Doença , Adulto , Idoso , Agorafobia/classificação , Agorafobia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/terapia , Psicoterapia Breve , Psicoterapia Psicodinâmica , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Suécia , Traduções
16.
Behav Cogn Psychother ; 47(2): 164-180, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29897024

RESUMO

BACKGROUND: Exposure is an effective intervention in the treatment of pathological anxiety, but it is insufficiently disseminated. Therapists' negative attitudes towards exposure might be of relevance when considering factors contributing to the non-application of this intervention. AIMS: In order to be able to measure concerns in German-speaking therapist populations, the study aimed at validating a German version of the Therapist Beliefs about Exposure Scale. METHOD: The scale was translated into the German language and validated in a sample of 330 German licensed cognitive behavioural therapists. RESULTS: In the present sample, the mean total score was significantly lower than in the original study including US-American therapists. Confirmatory factor analysis did not confirm the proposed one-factor model, while the exploratory factor analysis indicated that more than one factor is necessary to explain the structure of negative attitudes towards exposure. The internal consistency was high. Higher scores (more negative beliefs) were significantly correlated with older age, holding a master's degree (vs PhD), not being specialized in the treatment of anxiety disorders and with less experience with performance of exposure gained during clinical training. Negative beliefs about exposure were further associated with the self-reported average number of sessions spent on exposure in current treatment of post-traumatic stress disorder and panic disorder, and with negative attitudes towards application of exposure sessions presented in case vignettes. CONCLUSIONS: The German adaptation provides the opportunity of measuring concerns regarding application of exposure in German-speaking therapist populations. However, the presented data reveal suggestions for further scale development.


Assuntos
Pessoal Técnico de Saúde/psicologia , Ansiedade/terapia , Atitude do Pessoal de Saúde , Terapia Cognitivo-Comportamental/normas , Transtorno de Pânico/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Idoso , Ansiedade/psicologia , Análise Fatorial , Feminino , Alemanha , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Traduções
17.
Behav Modif ; 43(4): 564-586, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29862830

RESUMO

A three-session therapist-guided exposure treatment was tested in a consecutive series of eight primary health care patients suffering from panic attacks who specifically used distraction techniques as their primary safety behavior. The Panic Disorder Severity Scale Self-Report (PDSS-SR) was administered at baseline (1-3 weeks before the first session), and 1, 2, and 3 weeks after treatment. Weekly ratings on the Body Sensations Questionnaire (BSQ) and the Agoraphobic Cognitions Questionnaire (ACQ) during treatment were undertaken to explore when reliable change took place on these measures. The results showed a large within-group effect size on PDSS-SR ( d = 1.63); six of the eight patients were classified as responders, and four of them showed remission. Large effect sizes ( ds between 1.17 and 3.00) were seen also on BSQ and ACQ, as well as on agoraphobic avoidance, general level of anxiety, and depression. The results on BSQ and ACQ suggest that the fear of body sensations in most cases was reduced before a change occurred in agoraphobic cognitions. These results indicate that a brief three-session exposure-based treatment may be sufficient for this subgroup of panic patients. The findings need to be replicated under controlled conditions with larger samples and different therapists before more firm conclusions can be drawn. Future research should also focus on the relevance of dividing patients into subgroups based on type of safety behavior.


Assuntos
Terapia Implosiva/métodos , Transtorno de Pânico/terapia , Psicoterapia Breve/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento , Adulto Jovem
18.
Child Psychiatry Hum Dev ; 50(2): 268-277, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30078111

RESUMO

Panic disorder (PD) can result in significant functional impairment. Studies of cognitive behavioral therapy (CBT) for PD have demonstrated response rates ranging between 38 and 65%. D-cycloserine (DCS), a partial NMDA agonist, may enhance the effects of exposure-based therapy for PD in adults; however, no studies have examined its effect in adolescents with PD. This study examined the feasibility and acceptability of the use of DCS to augment intensive CBT for PD in adolescents. Twenty-four adolescents (ages 12-17) participated in this randomized, double-blinded, placebo-controlled trial, to compare CBT + DCS to CBT + placebo. The results demonstrated the feasibility and acceptability of the treatment to participants. No significant differences were found between the two groups, but both groups showed significant improvement. This is the first investigation of DCS in the treatment of PD in adolescents and it provides initial support for a more extensive study of DCS augmentation of CBT among adolescents with PD.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Ciclosserina/administração & dosagem , Medo/efeitos dos fármacos , N-Metilaspartato/agonistas , Transtorno de Pânico , Adolescente , Adulto , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Humanos , Terapia Implosiva , Masculino , Transtorno de Pânico/psicologia , Transtorno de Pânico/terapia , Pais , Psicotrópicos/administração & dosagem , Resultado do Tratamento
19.
J Anxiety Disord ; 61: 27-36, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287083

RESUMO

Trials of virtual reality exposure therapy (VRET) for anxiety-related disorders have proliferated in number and diversity since our previous meta-analysis that examined 13 total trials, most of which were for specific phobias (Powers & Emmelkamp, 2008). Since then, new trials have compared VRET to more diverse anxiety and related disorders including social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and panic disorder (PD) with and without agoraphobia. With the availability of this data, it is imperative to re-examine the efficacy of VRET for anxiety. A literature search for randomized controlled trials of VRET versus control or in vivo exposure yielded 30 studies with 1057 participants. Fourteen studies tested VRET for specific phobias, 8 for SAD or performance anxiety, 5 for PTSD, and 3 for PD. A random effects analysis estimated a large effect size for VRET versus waitlist (g = 0.90) and a medium to large effect size for VRET versus psychological placebo conditions (g = 0.78). A comparison of VRET and in vivo conditions did not show significantly different effect sizes (g = -0.07). These findings were relatively consistent across disorders. A meta-regression analysis revealed that larger sample sizes were associated with lower effect sizes in VRET versus control comparisons (ß = -0.007, p < 0.05). These results indicate that VRET is an effective and equal medium for exposure therapy.


Assuntos
Transtornos de Ansiedade/terapia , Terapia de Exposição à Realidade Virtual , Agorafobia/terapia , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Humanos , Terapia Implosiva , Transtorno de Pânico/terapia , Fobia Social/terapia , Transtornos Fóbicos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Transtornos de Estresse Pós-Traumáticos/terapia
20.
Eur Arch Psychiatry Clin Neurosci ; 269(2): 161-170, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28712090

RESUMO

Although cognitive behavioral therapy (CBT) is highly effective in the treatment of anxiety disorders, many patients still do not benefit. This study investigates whether a history of traumatic event experience is negatively associated with outcomes of CBT for panic disorder. The moderating role of the monoamine oxidase A (MAOA) gene and depression symptoms as well as the association between trauma history and fear reactivity as a potential mechanism are further analyzed. We conducted a post-hoc analysis of 172 male and 60 female patients with panic disorder treated with CBT in a multi-center study. Treatment outcome was assessed at post-treatment using self-report and clinician rating scales. Fear reactivity before treatment was assessed via heart rate and self-reported anxiety during a behavioral avoidance test. Among females, we did not find any differences in treatment response between traumatized and non-traumatized individuals or any two-way interaction trauma history × MAOA genotype. There was a significant three-way interaction trauma history × MAOA genotype × depression symptoms on all treatment outcomes indicating that in traumatized female patients carrying the low-activity allele, treatment effect sizes decreased with increasing depression symptoms at baseline. No such effects were observed for males. In conclusion, we found no evidence for a differential treatment response in traumatized and non-traumatized individuals. There is preliminary evidence for poorer treatment outcomes in a subgroup of female traumatized individuals carrying the low-active variant of the MAOA gene. These patients also report more symptoms of depression symptomatology and exhibit a dampened fear response before treatment which warrants further investigation.


Assuntos
Terapia Cognitivo-Comportamental , Depressão/fisiopatologia , Medo/fisiologia , Monoaminoxidase/genética , Transtorno de Pânico/terapia , Trauma Psicológico/terapia , Adulto , Comorbidade , Depressão/epidemiologia , Depressão/genética , Feminino , Humanos , Masculino , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/genética , Trauma Psicológico/epidemiologia , Trauma Psicológico/genética , Fatores Sexuais
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