Anxiety Management Group Research Articles

75 The COVID-19 pandemic and social frailty: an evaluation of Occupational Therapy practice in a day hospital

Abstract Background Restrictions imposed to limit transmission of COVID-19 and to protect vulnerable persons led to loss of roles and routines, social isolation, sedentary lifestyles, increased anxiety, depression, and increased frailty among older people. In Occupational Therapy (OT) literature, ‘occupational deprivation’ describes this state of enforced disengagement in meaningful occupations which negatively impacts wellbeing. Clients attending a Day Hospital for Comprehensive Geriatric Assessment (CGA) reported residual elements of occupational deprivation and negative effects of COVID-19 restrictions with associated social frailty. OT practice was evaluated to determine the extent of services offered to remediate or improve social frailty and overall wellbeing. Methods During CGA, OTs assess clients’ occupational performance including cognition, mood, mobility, social environment and engagement in meaningful occupations. Routine (quantitative) data collected to evaluate the service was inputted and analysed using Microsoft Excel. OTs logged numbers of clients referred to services to remediate social frailty including day centres, social prescribing and an OT-led anxiety management group in the Day Hospital. Six months of data in 2023 was analysed. Results 288 clients received CGA by OT. The average age was 83. 33% were referred to Memory Technology Resource Rooms. 6% were referred to Day Centres or Active Retirement. 7% were referred to OT anxiety management group in the Day Hospital. 3% were referred to ALONE befriending. As part of routine OT practice, almost all clients were advised to continue with or to re-engage with previously enjoyed (meaningful) occupations such as attending mass, playing bridge, and visiting friends. Conclusion Occupational deprivation experienced by older adults during the COVID-19 pandemic contributes to increased social frailty. Older adults attending a Day Hospital received routine OT intervention focusing on enhancing their wellbeing and reversing social frailty associated with the COVID-19 restrictions. Assessment and management of social frailty is vital to understand the effects of the pandemic on older people and provide appropriate services.

Intervenção e manejo de ansiedade em estudantes do ensino médio integrado

Os Institutos Federais de Educação, Ciência e Tecnologia, implementados em 2008, integram o ensino profissional e o ensino médio com base no ideal de Formação Humana Integral dos sujeitos. Nesse sentido, o presente trabalho tem como objeto de estudo a ansiedade em estudantes do Ensino Médio Integrado de um Instituto Federal de Ensino. Pesquisas recentes abordam sobre as metodologias, carga horária extensa e estrutura curricular como possíveis contribuintes para transtornos de ansiedade em adolescentes estudantes do Ensino Médio Integrado. Deste modo, esta pesquisa buscou identificar os resultados de um Grupo de Intervenção, baseado em Terapia Cognitivo-Comportamental (TCC), para o Manejo da ansiedade em estudantes do Ensino Médio Integrado. Trata-se de uma pesquisa transversal, de caráter quantitativo. Utilizou-se a escala de avaliação da ansiedade de Hamilton – HAM- A como instrumento de coleta de dados e de avaliação da intervenção realizada. Doze estudantes do Ensino Médio Integrado do IFNMG - Campus Januária participaram das atividades psicoeducativas, de reestruturação cognitiva e de mudanças comportamentais. Como resultados desta pesquisa, concluiu-se que o Grupo de Intervenção e Manejo da Ansiedade foi eficiente ao reduzir o nível de ansiedade de 92% das participantes. Como sugestão para trabalhos futuros, sugere-se a criação de um protocolo padrão de intervenção para os transtornos da ansiedade em estudantes do EMI, a ser utilizado por psicólogos escolares, a fim de promover o suporte emocional a estudantes desta modalidade de ensino e, consequentemente, contribuir com o bem-estar, com a aprendizagem, com a saúde mental e com a Formação Humana Integral desses estudantes.

Targeting anxiety to improve quality of life in patients with schizophrenia

BackgroundSeveral studies suggested that anxiety can significantly affect the outcome of schizophrenia. Despite this evidence, non-pharmacological interventions targeting anxiety are still heterogenous. This study aims to test the efficacy of a novel training specifically designed to target anxiety in patients with schizophrenia. Innovatively, this training, beyond psychoeducation and problem solving, also targets Theory of Mind, as it provides coping strategies. MethodTwenty-seven outpatients with schizophrenia received a novel rehabilitative training targeting anxiety (Anxiety Management Group [AMG]) combined with a Computer-Assisted Cognitive Remediation (CACR), and twenty received CACR plus a control intervention (Control Newspaper discussion Group [CNG]). All patients were assessed at baseline and after treatment for quality of life, neurocognition and anxiety. ResultsAfter training, patients treated with AMG+CACR showed significantly greater improvements on anxiety. A significant increase in quality of life was observed only for AMG+CACR group. Moreover, the participants’ appraisal showed a significant difference between treatment groups with higher ratings among patients who received the AMG+CACR. ConclusionsThis study thus suggests feasibility and efficacy of the proposed intervention, that could be implemented in rehabilitative programs for patients with schizophrenia with potential benefits also on disease course and outcome.

Efficacy of Cognitive Behaviour Therapy versus Anxiety Management for Body Dysmorphic Disorder: A Randomised Controlled Trial

Background: The evidence base for the efficacy of cognitive behaviour therapy (CBT) for treating body dysmorphic disorder (BDD) is weak. Aims: To determine whether CBT is more effective than anxiety management (AM) in an outpatient setting. Method: This was a single-blind stratified parallel-group randomised controlled trial. The primary endpoint was at 12 weeks, and the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) was the primary outcome measure. Secondary measures for BDD included the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI) and the Body Image Quality of Life Inventory (BIQLI). The outcome measures were collected at baseline and week 12. The CBT group, unlike the AM group, had 4 further weekly sessions that were analysed for their added value. Both groups then completed measures at their 1-month follow-up. Forty-six participants with a DSM-IV diagnosis of BDD, including those with delusional BDD, were randomly allocated to either CBT or AM. Results: At 12 weeks, CBT was found to be significantly superior to AM on the BDD-YBOCS [β = -7.19; SE (β) = 2.61; p < 0.01; 95% CI = -12.31 to -2.07; d = 0.99] as well as the secondary outcome measures of the BABS, AAI and BIQLI. Further benefits occurred by week 16 within the CBT group. There were no differences in outcome for those with delusional BDD or depression. Conclusions: CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over 12 weeks.

LIFT psychology primary care group for people with intellectual disabilities: can IAPT adapt?

Purpose – There is a move to make primary care models of mental health care more accessible to people with intellectual disabilities (IAPT, 2009) but little evidence of their ability of services to make the necessary reasonable adjustments or their effectiveness (Dodd et al., 2011). The purpose of this paper is to describe a pilot project to evaluate an anxiety management group co-facilitated by Least Intervention First Time (LIFT) Psychology and Community Team for People with Learning Disabilities (CTPLD) services. Design/methodology/approach – Five people attended a nine-week anxiety management group, adapted from a course offered by LIFT services. The Glasgow Anxiety Scale (GAS-ID) and a skills and knowledge assessment were completed pre-group, post-group and follow-up to evaluate outcome and consider the ability of LIFT to make reasonable adjustments to deliver effective services for people with intellectual disabilities. Findings – Participants showed no significant reduction in anxiety levels but improvements in their skills and knowledge. An evaluation of the adjustments to make the group accessible for people with intellectual disabilities identified that some were feasible if offering the group on a long-term basis, and others were not. The viability of future groups is considered. Originality/value – The paper looks at the viability of making reasonable adjustments to psychoeducational groups within Improving Access to Psychological Therapies services to better meet the needs of people with intellectual disabilities, an area of limited research. It raises dilemmas and considerations for the future development of such services.

COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL

High rates of anxiety disorders, particularly obsessive compulsive disorder (OCD) are reported in people with Autism spectrum disorders (ASD). Group cognitive behavioral treatment (CBT) has been found effective for anxiety in young people with ASD but not been OCD specific. One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy. Forty-six adolescents and adults (mean age 26.9 years, 35 Males) with ASD and comorbid OCD were randomized to CBT for OCD or anxiety management (AM), a plausible control treatment. Treatments were matched in duration (mean of 17.4 sessions CBT; 14.4 sessions AM), the Yale-Brown Obsessive Compulsive Severity Scale (YBOCS) as primary outcome measure and evaluations blind to treatment group. Treatment response was defined as > 25% reduction in YBOCS total severity scores. Both treatments produced a significant reduction in OCD symptoms, within-group effect sizes of 1.01 CBT group and 0.6 for the AM group. There were no statistically significant differences between the two groups at end of treatment, although more responders in the CBT group (45 versus 20%). Effect sizes for self-rated improvement were small (0.33 CBT group; -0.05 AM group). Mild symptom severity was associated with improvement in the AM but not the CBT group. Family/carer factors were important for both groups, in that increased family accommodation was associated with poorer outcome. Evidence-based psychological interventions, both AM and CBT, were effective in treating comorbid OCD in young people and adults with ASD.

Evaluating an anxiety group for people with learning disabilities using a mixed methodology

Accessible Summary We held an anxiety group for people with learning disabilities The group ran for 6 weeks and eight people came After the group, we found out if people felt better. We did this by asking them what was good about the group and asking them to fill out questionnaires. SummaryThe effectiveness of group therapy for people with learning disabilities and anxiety management issues is reviewed. People with learning disabilities face increased levels of psychological distress compared to the general population, yet are often faced with a lack of social support and poor coping techniques to manage their distress. A 6‐week cognitive behavioural therapy (CBT) anxiety management group was delivered to eight adults with a mild learning disability by a trainee psychologist and an assistant psychologist. Participants' ages ranged from 17 to 73 years. All participants lived in the local community. Not all participants had a specific anxiety diagnosis, but all required anxiety management input. A mixed methodology using quantitative and qualitative analysis of group outcomes was used. The outcomes from this group suggest that the intervention was successful in treating anxiety for people with learning disabilities. Measures included the Quality of Life Scale, the Glasgow Anxiety Scale and the Health of the Nation Outcome Scale–Learning Disability Version. Interpretative Phenomenological Analysis (IPA) was also used. Data from interviews were coded and analysed thematically. The main themes that emerged included group versus individual input, helpful aspects of the group, talking in front of other people, group composition (including age differences), support partners, and written materials. The outcomes for this group suggest that the intervention was successful in treating anxiety for people with learning disabilities. Practical applications of group therapies for these clients are considered, and recommendations for future groups made. Quantitative and qualitative evaluation methods are compared.

A preliminary evaluation of a 6 week Anxiety Management Group for patients with Chronic Obstructive Pulmonary Disease (COPD)

Rationale, aims and objectives: Anxiety associated with breathlessness occurs at a high rate in people with chronic obstructive pulmonary disease (COPD), yet few clinical studies have examined the usefulness of psychological intervention to manage anxiety in this population. To address this issue a six week anxiety management group for patients with COPD was established in a UK hospital. This article describes an evaluation of the group. The purpose of evaluation was to obtain feedback from patients (n=12) about the usefulness of the group to manage anxiety associated with breathlessness. Method: Evaluation data included a self-devised audit tool, the hospital anxiety and depression scale (HADS), patient self report and an evaluation form. Results: COPD patients are often frightened by their experience of breathlessness. The anxiety management group helped patients understand the link between breathlessness and anxiety. They also reported gains in their psychological knowledge of anxiety, maintaining factors and management strategies. Conclusions: The evaluation has shown that clinical care of COPD patients can be enhanced through psychological and patient centred interventions. Clinical practice can be improved further by seeking ways to maximise patient attendance and routinely consulting with service users about aspects of their care.

Evaluating an anxiety management group for people with a learning disability who are isolated in their own community

This paper examines the effectiveness of an anxiety management programme for adults who have a learning disability. The group was set in the community. Participants were identified and recruited via local GPs and members of a multi-disciplinary team. These individuals were identified as isolated in their own communities. Participants completed pre- and post-assessments. The data of five participants who completed both assessments are included in this paper. The data is not included from those service users who attended the group but did not complete both parts. Four of the participants demonstrated a reduction in anxiety levels. The participants also identified that the group promoted choice, inclusion and empowerment, themes that were integral to the development of the group.

A randomized controlled trial comparing an adult education class using cognitive behavioural therapy (“stress control”), anxiety management group treatment and a waiting list for anxiety disorders

Background: Anxiety disorders are extremely common and regularly treated in group settings. At present there is limited evidence for the effectiveness of group anxiety management courses.Aims: To examine the relative efficacies of a six week cognitive behavioural adult education evening class, a traditional anxiety management group and a waiting list group in the treatment of anxiety disorders.Method: Individuals with a DSM IV anxiety disorder were randomized to either a cognitive behavioural therapy adult education evening class (Stress Control), anxiety management group treatment or a waiting list control condition. Both active treatments lasted 2 hours per week for 6 weeks in total.Results: There were no significant differences between any of the groups on the main outcome measure. Stress Control and Anxiety Management showed significantly greater mean reductions on the Fear Questionnaire than the Waiting List group post-treatment but this difference was no longer present at one month follow-up. There were no differences at any time point between anxiety management and Stress Control. The initial presence of depression was highly predictive of poor outcome.Conclusions: This study does not support the routine use of Stress Control or Anxiety Management in group settings for individuals referred to secondary care with anxiety disorders. Further research is required to determine if specific individuals would benefit from these approaches or whether they should be included in a stepped-care pathway for the treatment of anxiety disorders.

Editorial

Editorial

Experiences of running an anxiety management group for people with a learning disability using a cognitive behavioural intervention

Accessible summary • We ran a group for 6 people with a learning disability who worry a lot. The group last for 12 weeks and each person in the group brought someone with them. • People said they found the group helpful. People said they learnt ways to cope when they get worried. • This research will help staff to think about how they can help people who worry a lot. More research is needed to find out which bits of the group were most helpful. Summary An anxiety management group utilizing a cognitive behavioural intervention, of 12 weeks duration, for six people with mild to moderate learning disabilities is described. A number of techniques to assist in developing clients’ understanding of their anxiety, cognitive and behavioural coping strategies and maximizing generalizability of skills learnt were implemented. Outcome measures demonstrated that two participants showed a clinically significant reduction in anxiety levels. Qualitative feedback from both participants and carers suggested that all group members developed coping strategies. Measures also indicated that carers demonstrated a better understanding of the individual's difficulties and were able to support them more effectively. Adopting a cognitive behavioural approach proved valuable and recommendations for future interventions are made.

Group Cognitive Behavioural Therapy for Heterogeneous Anxiety Disorders

Evidence assessing the outcome of cognitive behavioural therapy for anxiety is based on protocols specifically tailored for individual disorders. To date, there is little research that would assess a mode of delivery that is designed for routine service delivery in typical clinical settings, i.e. group cognitive behavioural therapy for unselected, mixed groups of anxiety disorders. The objective of this pilot study is to use program evaluation methods to assess the immediate and enduring improvements following a 12-week Anxiety Management Group. Group participants had any of 5 anxiety disorders and described related avoidance. The weekly 2-hour group sessions and daily homework tasks were guided by a participant handbook. Patients completed questionnaires at baseline and group completion (n = 70); a subset also provided 6-month follow-up data. The results from post-group scores on 2 self-report measures show immediate reductions equivalent to an effect size of eta = 0.73 (p < 0.001). The effect is maintained at 6-month follow-up. This program evaluation suggests that group cognitive behavioural therapy for heterogeneous anxiety disorders may be effective in a routine clinical setting. A more rigorous study of this heterogeneous format appears justified.

A comparison of two treatment interventions aimed at lowering anxiety levels and alcohol consumption amongst alcohol abusers

This study compared the differential efficacy of anxiety management and relaxation training — with respect to their impact on anxiety levels and alcohol consumption amongst people attending an Alcohol Treatment Unit. It was hypothesised that anxiety management would have a greater effect on the outcome measures than would relaxation training and that the effect on alcohol consumption would be moderated by changes in the clients' perceptions of their ability to control their drinking. The two treatment groups were found to significantly reduce self-reported anxiety with the anxiety management group being more effective than relaxation training. They had no impact on alcohol consumption.

Anxiety and stress management

List of illustrations. Acknowledgements. Preface. Editor's Introduction. 1. What We Know about Stress - A Model Based on Research 2. Diagnostic Classification and Theories of Anxiety 3. Assessment 4. Anxiety and Stress - The Process of Education 5. Self-Help Techniques Explained 6. Helping Clients to Change their Lifestyles 7. Running an Anxiety Management Group 8. Some Case-Study Examples of Treating Anxiety and Stress. References. Name Index. Subject Index.

An anxiety management group: strengths and pitfalls

An anxiety management group, which used adaptations of traditional cognitive‐behavioural techniques, was offered to eight adults with mild or moderate mental handicaps. Group members reported that sharing their experiences of anxiety, and learning new skills, such as abdominal breathing and relaxation, were the most effective methods employed. Suggested changes for the organisation of future groups are considered.