Outpatient Anxiety Disorders Clinic Research Articles

False safety behaviour elimination therapy for social anxiety disorder in Japanese men

ABSTRACT Background Social anxiety disorder (SAD) is an excessive fear of social situations that can lead to serious functional impairment. The prevalence of SAD has increased over the past four decades, making it one of the most prevalent psychiatric disorders in Japan. Therefore, more effective interventions are needed to treat this disorder. False safety behavior elimination therapy (F-SET), which eliminates safety behavior (i.e., strategies that reduce anxiety), was administered in our study to six Japanese patients with SAD. This is the first adaptation of F-SET into Japanese. Patients were diagnosed using the Mini-International Neuropsychiatric Interview. The Liebowitz Social Anxiety Scale was used as the primary outcome measure to evaluate the change in symptoms. All patients received five weekly 60-minute F-SET sessions. Results and Conclusions Participants who completed the treatment exhibited a substantial decrease in SAD symptoms, providing preliminary support for the adapted treatment’s efficacy. We have discussed the cultural differences in SAD and the adaptation of F-SET. KEY POINTS What is already known about this topic: (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Few studies have examined the effectiveness of transdiagnostic group CBT in naturalistic settings. (3) Few studies have examined the effectiveness of treatments as implemented by clinicians in routine clinical practice. What this paper adds: (1) Eight to ten sessions of transdiagnostic group CBT developed by practising clinicians seemed sufficient in improving anxiety and depressive symptoms, daily functioning, and quality of life in patients from an outpatient anxiety disorders clinic in a hospital setting. (2) Patients that completed treatment reported significantly more impairment in daily functioning before treatment than participants who dropped out. (3) High attrition rates suggest that organisational factors need to be considered while implementing evidence-based treatments into routine clinical practice.

Integrated group treatment for anxiety disorders: a transdiagnostic effectiveness and feasibility study in a mental health hospital setting

ABSTRACT Objective The development of transdiagnostic cognitive-behavioural therapy (T-CBT) is a promising avenue for the treatment of anxiety disorders. This study aimed at evaluating the feasibility and effectiveness of a group T-CBT, developed by practising clinicians, for patients with principal and comorbid anxiety disorders in a pragmatic quasi-experimental trial. Method Clinician-rated and self-rated measures were used to assess principal (anxiety) and secondary (depression, daily functioning, quality of life) outcomes. Forty-two participants from an anxiety outpatient clinic of a mental health hospital with at least one primary anxiety disorder took part in the study. The intervention consisted of 8 to 10 weekly group T-CBT sessions of 120 minutes. Results Among the 42 participants recruited, 37 completed baseline measures. Attrition was high (35%) as only 24 participants completed the treatment as intended. Significant improvements were observed on anxiety, depression, and daily functioning as well as physical and psychological quality of life measures. Gains were maintained up to three months after the end of treatment. Conclusion Findings support the effectiveness of a group T-CBT for anxiety disorders in an outpatient clinic. However, feasibility was only partially supported highlighting the need for further research on the transportability of group T-CBT in to clinical practice. KEY POINTS What is already known about this topic: (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Few studies have examined the effectiveness of transdiagnostic group CBT in naturalistic settings. (3) Few studies have examined the effectiveness of treatments as implemented by clinicians in routine clinical practice. What this paper adds: (1) Eight to ten sessions of transdiagnostic group CBT developed by practising clinicians seemed sufficient in improving anxiety and depressive symptoms, daily functioning, and quality of life in patients from an outpatient anxiety disorders clinic in a hospital setting. (2) Patients that completed treatment reported significantly more impairment in daily functioning before treatment than participants who dropped out. (3) High attrition rates suggest that organisational factors need to be considered while implementing evidence-based treatments into routine clinical practice.

Shyness and anxiety: Protective role of extraversion

The present study examined the moderating role of extraversion in explaining the relation between shyness and anxiety in a non-clinical early adolescent sample (N = 119, nfemale = 75; Mage = 12.93 years, SDage = 2.23 years) and a clinical adult sample from an outpatient anxiety disorders clinic (N = 100, nfemale = 77; Mage = 34.97 years, SDage = 12.66 years). We found evidence for the protective role of relatively high levels of extraversion in both samples, such that shyness was positively associated with anxiety in the context of relatively low levels of extraversion. Our results provide support for the protective role of extraversion in the presence of high levels of shyness.

Internet-based cognitive behavioral therapy for anxiety in an outpatient specialized care setting: A qualitative study of the patients' experience of the therapy.

Knowledge about user experiences of internet-based cognitive behavioral therapy (iCBT) has mostly been drawn from non-clinical groups or with iCBT offered via self-referral. The present study therefore focused on patients who had undergone iCBT with minimal support while actively awaiting outpatient psychological treatment in the form of face-to-face CBT. To seek out barriers to adherence the study also included patients who had withdrawn from the iCBT treatment before completion. The study was performed in an outpatient clinic for anxiety disorders where twelve participants with a primary diagnosis of either social anxiety disorder or panic disorder were recruited from an ongoing randomized control trial for semi-structured interviews. Statements from the interviews showed that the iCBT treatment was unfavorably compared to the usual face-to-face treatment at the clinic. Despite this, a majority of the interview participants still expressed to have experienced various benefits from the treatment. Some participants did however, experience difficulties putting the materials to practical use. Furthermore, a large majority of the participants expressed a need for additional support, with a strong tendency for non-completers specifically expressing a need for face-to-face contact with a clinician. Implications for future research and implementation of iCBT in clinical practice are discussed.

Poor insight in obsessive-compulsive disorder: Examining the role of cognitive and metacognitive variables

The purpose of the current study was to examine the cognitive and metacognitive constructs that conceptually relate to poor insight in obsessive-compulsive disorder (OCD). Associations between various dimensions of insight in OCD (e.g., clinical insight, conviction in one's beliefs) and cognitive and metacognitive variables (e.g., cognitive insight, decentering) were examined. Participants with OCD (N = 80) referred for treatment at an outpatient anxiety disorders clinic completed a clinical interview and a computer-administered questionnaire package assessing the variables of interest. Cognitive insight, a type of metacognitive process, was significantly negatively associated with delusional thinking, and cognitive self-consciousness was significantly negatively correlated with delusional thinking regarding a psychiatric source for one's symptoms. Finally, insight decreased during recall of times when OCD symptoms were activated for both the good and poor insight groups, and did not significantly vary as a function of insight group status. Implications, limitations, and directions for future research are discussed.

Peer victimization among children and adolescents with anxiety disorders.

This study examined peer victimization among a sample of youth who were seeking treatment at an outpatient anxiety disorders clinic. The study examined the association between peer victimization and internalizing symptoms and looked at whether frequent victimization was more common among youth with Social Phobia (SoP) as compared to youth with other anxiety disorders The study also examined the relation between SoP and peer victimization dimensionally. Participants were 90 youth (47 boys; M age = 11.06 years) and their parents. Results showed that peer victimization was associated with social anxiety symptoms, and relational victimization, in particular, was associated with internalizing problems among youth with anxiety disorders. Negative beliefs about the peer group accounted for some of this relation. Victimization was associated with symptomatology rather than diagnosis. Peer victimization is important to assess and consider in the treatment of anxiety disorders in youth.

Perceived Control is a Transdiagnostic Predictor of Cognitive-Behavior Therapy Outcome for Anxiety Disorders.

Perceived control has been proposed to be a general psychological vulnerability factor that confers an elevated risk for developing anxiety disorders, but there is limited research examining perceived control during cognitive-behavioral therapies (CBT). The present study examined whether treatment resulted in improvements in perceived control, and the indirect effects of CBT on changes in symptoms of obsessive-compulsive disorder, social phobia, generalized anxiety disorder, and panic disorder via changes in perceived control. Participants (n = 606) were a large clinical sample presenting for treatment at an outpatient anxiety disorders clinic. Participants completed a series of self-report questionnaires and a structured clinical interview at an intake evaluation and at two follow-up assessments 12 and 24 months later, with the majority of participants initiating CBT between the first two assessments. Results of latent growth curve models indicated that individuals initiating CBT subsequently reported large increases in perceived control and significant indirect effects of treatment on intraindividual changes in each of the four anxiety disorders examined via intraindividual changes in perceived control. These results suggest that the promotion of more adaptive perceptions of control is associated with recovery from anxiety disorders. Furthermore, the consistent finding of indirect effects across the four anxiety disorders examined underscores the transdiagnostic importance of perceived control in predicting CBT outcomes.

Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment

The current study examined changes in social anxiety thoughts and beliefs following cognitive-behavioral treatment (CBT). Participants (N = 77) were adults with a principal diagnosis of SAD who received 12, 2-h sessions of group CBT at a hospital-based outpatient anxiety disorders clinic. There were significant decreases from pretreatment to posttreatment in social anxiety symptoms and in symptoms of depression, nonspecific anxiety and tension, as well as significant improvements in social anxiety beliefs, as assessed via the Social Thoughts and Beliefs Scale (STABS; Turner et al., Psychol Assess 15:384–391, 2003). Change in social anxiety beliefs made a significant contribution to the prediction of social anxiety symptoms at posttreatment over and above pretreatment social anxiety symptoms and changes in depression, nonspecific anxiety and tension. A positive change in the belief that others are more socially-competent emerged as a significant unique predictor of social anxiety symptoms at posttreatment. The findings demonstrate that the STABS is sensitive to cognitive-behavioral treatment. The findings also suggest that social comparison processes in particular are a key aspect of improvement in social anxiety symptoms. This is an important direction for future research.

Can levels of a general anxiety-prone cognitive style distinguish between various anxiety disorders?

BackgroundThe question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. ObjectivesThis study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. MethodsThe Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90—Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. ResultsPatients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. ConclusionsThe general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders.

Hoarding among patients seeking treatment for anxiety disorders

The aim of the present study was to examine the prevalence of hoarding symptoms among individuals presenting for treatment of anxiety symptoms. Participants included 130 adults who were seeking treatment at an outpatient anxiety disorders clinic between January 2004 and February 2006. During their initial assessment, participants (31 with panic disorder, 15 specific phobia, 27 social phobia, 36 obsessive-compulsive disorder, 21 generalized anxiety disorder, mean age 37 years, 57% female, 88% White) completed the Saving Inventory-Revised, a self-report measure of hoarding symptoms, and several measures of anxiety symptoms, depressive symptoms, and functional impairment. Approximately 12–25% of anxious patients reported significant hoarding symptoms. Patients diagnosed with generalized anxiety disorder and obsessive-compulsive disorder were more likely to report significant hoarding symptoms than were those with panic disorder or specific phobia. Hoarding symptoms were positively correlated with trait anxiety, depressive symptoms, and functional impairment. These findings suggest that hoarding symptoms may be associated with anxiety disorders other than obsessive-compulsive disorder. The findings further suggest that hoarding symptoms may be underreported by anxious populations since typical intake assessments do not include specific questions about hoarding and individuals with hoarding symptoms may be unlikely to spontaneously report them.

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

Quality of life and anxiety and depressive disorder comorbidity

The present investigation evaluated the relations among anxiety and depressive disorder comorbidity and quality of life (QOL) by utilizing self-report measures of life satisfaction and functional disability. Participants were 94 individuals who were presented for treatment at an outpatient anxiety disorders clinic and 26 nonclinical participants. Results indicated that participants diagnosed with anxiety disorders reported lower QOL than did nonclinical participants. Anxiety disorder comorbidity did not additionally impact QOL; however, presence of a depressive disorder comorbid with an anxiety disorder did negatively impact QOL as these individuals reported significantly more functional disability and less life satisfaction than did individuals with anxiety disorders alone or those without a psychiatric diagnosis. These results highlight the negative nature of anxiety disorders and improve clarification on the role of diagnostic comorbidity on QOL among those with an anxiety disorder.

Quality of Life in Obsessive-Compulsive Disorder: The Different Impact of Obsessions and Compulsions

Background: Patients with obsessive-compulsive disorder (OCD) are troubled by repeated obsessions and/or compulsions, which seem senseless and frequently repugnant. Objective: The study examines the differential impact of obsessions and compulsions on the quality of life (QoL) of patients with OCD. Methods: Seventy-five patients (43 females, 32 males) between 21 and 62 years old with OCD (ICD 10 F42.0–F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. The severity of OCD symptoms was assessed by the Yale Brown Obsessive-Compulsive Scale (a standardized, clinician-administered scale), and depressiveness was assessed with the Beck Depression Inventory (a self-report instrument). QoL was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by WHO. Results: Compulsions reduced patients’ QoL in the WHOQOL-BREF domains ‘physical well-being’, ‘psychological well-being’ and ‘environment’, whereas obsessions did not have any impact on QoL ratings. Depressive symptoms were a strong predictor of poor QoL in OCD patients. Conclusions: In order to judge the QoL of OCD patients, obsessions and compulsions have to be considered differently. Diagnosing and treating depressive symptoms is important for improving the QoL in OCD.

Subjektive Lebensqualität von Patienten mit Zwangserkrankungen im Vergleich mit der Allgemeinbevölkerung

Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with impaired social functioning, which impact their everyday life negatively. Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population. 75 patients with OCD (ICD-10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. Patients showing psychiatric co-morbidity were excluded. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD and in a sample of the general population of Saxony/Germany. Compared with the general population, QoL in patients with obsessive-compulsive disorders was lower in all domains of the WHOQOL-BREF. OCD has a substantial adverse effect on patients' subjective QoL. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Subjective quality of life of patients with obsessive–compulsive disorder

Obsessive-compulsive disorder (OCD) is the fourth most frequent diagnosis in psychiatry. Patients with OCD suffer from obsessive thinking and compulsive behavior, which impact their everyday life negatively. Subjective quality of life (QoL) in patients with OCD was examined and compared to the general German population and to patients with schizophrenia. Seventy-five patients, aged 21-72, with OCD (ICD 10 F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders at the Department of Psychiatry of the University of Leipzig. By means of the WHOQOL-BREF, QoL was assessed in patients with OCD in a representative sample of patients with schizophrenia and in a sample of the general population of Saxony/Germany. Compared with the general population, QoL in patients with OCDs was lower in all domains of the WHOQOL-BREF. Unexpectedly, QoL in patients with OCDs was lower in the domains "psychological well-being" and "social relationships" when compared with schizophrenia patients. OCD has a substantial adverse effect on patients' subjective QoL, which may be even greater than the adverse effect of schizophrenia. Therefore, it will be necessary to include interventions in the treatment of OCD aimed at improving residual deficits in psychosocial functioning and QoL.

Quality of life of relatives of patients with obsessive-compulsive disorder

Background Obsessive-compulsive disorder (OCD) affects the lives of both patients and their relatives. Clinical observations suggest that family members of patients with OCD are involved in the patients' rituals, often impairing their own everyday life. Objective The objective of this study was to compare the quality of life (QoL) of relatives of patients with OCD with that of the general German population. Methods Seventy-four relatives (29 parents, 33 spouses, 8 children, and 4 siblings) of patients with OCD ( International Statistical Classification of Diseases, 10th Revision F42.0-F42.2) were recruited from the outpatient clinic for anxiety disorders of the University of Leipzig Department of Psychiatry. The WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organization, assessed QoL. These findings were compared with the QoL of a representative sample of the general German population. Results Compared with that of the general population, the QoL of relatives of patients with OCD was significantly lower in the domains physical well-being, psychologic well-being, and social relationship. Conclusions Obsessive-compulsive disorder has an adverse effect on the subjective QoL of relatives of patients with OCD. Therefore, these findings suggest that professionals working with relatives must focus not only on the care given to persons with an illness but also on their relatives' situation and personal QoL.

Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders.

Treatment attrition represents a considerable problem for efficient delivery of care for mental disorders. The present study examined rates and predictors of pretreatment attrition and dropout from outpatient treatment for anxiety disorders. The influence of clinical, demographic, clinician and system variables on pretreatment attrition (treatment refusal or non-attendance) and dropout were analysed in a consecutive sample of 731 clients treated at an anxiety disorders clinic in Sydney. Pretreatment attrition was common (30.4%) but dropout once clients had commenced treatment was rare (10.3%). Milder pretreatment symptoms were associated with treatment dropout and comorbid depression or depressive symptoms were associated with higher probability of both pretreatment attrition and dropout. Demographic, clinician and system influences were present but less important. Targeting of individuals with comorbid anxiety and depression may reduce treatment attrition rates among individuals with anxiety disorders presenting for treatment.

Rationing of health care:: Clinical decision making in an outpatient clinic for anxiety disorders

Anxiety disorders are prevalent and disabling and despite the fact that effective interventions are available, many people do not access effective treatment. Clinician decisions are fundamental determinants of access to this treatment. Despite this, treatment decisions have never been examined specifically in this group and are rarely examined in outpatient settings. The present study assessed 550 consecutive referrals to an anxiety disorders clinic in Sydney, Australia. Logistic regression was used to examine the predictors of decisions about treatment. Clinical patient variables (diagnosis and disability) were the strongest predictors of an offer of treatment but demographics and resource availability were also significant. Some of the same factors have been shown to influence the decision to seek treatment for anxiety. Both help-seeking behavior and treatment decision making are important determinants of access to care and both should be examined in future studies.

Predictors of outcome in panic disorder: A 5-year prospective follow-up study

A prospective 5-year follow-up study in patients with panic disorder was carried out in order to determine predictors of outcome. 50 patients presenting at an outpatient clinic for anxiety disorders were enroled initially in a controlled treatment study using either imipramine or doxepin in addition to supportive psychotherapy and were then followed under naturalistic treatment conditions. By means of multiple stepwise regression analyses comorbidity with current depression, severity of illness and agoraphobic avoidance turned out to be the strongest predictors. These data confirm the findings of shorter-term prospective follow-up studies and of retrospective studies. In contrast to several reports, illness-related social impairment at baseline was not found to affect outcome.

Structure of anxiety and the anxiety disorders: A hierarchical model.

The authors used a semistructured clinical interview and a self-report battery of questionnaires to measure key features of the anxiety disorders in a large sample of patients seeking treatment at an outpatient anxiety disorders clinic and in a no mental disorder group. Results were consistent with hierarchical models of anxiety and the anxiety disorders such as the model implicit in American Psychiatric Association (1987, 1994) and trait models positing a trait diathesis common to all the anxiety disorders. A higher order general factor differentiated each of the patient groups from the no mental disorder group. Several lower order factors provided the basis for differentiation among the patient groups. Conclusions regarding the degree to which models predicting a hierarchical structure of anxiety and the anxiety disorders are empirically supported must await replication of these results with additional samples.