Psychological Treatments For Anxiety Disorders Research Articles

Developing and disseminating effective psychological treatments: Science, practice and economics.

In many countries there is growing interest in the identification, development, and dissemination of evidence based psychological therapies. The cognitive– behaviour therapy (CBT) movement has been particularly successful in developing effective new treatments. It has been suggested this is partly because of the close interplay between theory, experimental psychopathology, and treatment development that characterizes much of CBT research. This article provides an illustration of such an interplay before moving on to discuss one of the world’s largest attempts to disseminate evidence-based therapies to the general public. The English Improving Access to Psychological Therapies (IAPT) program aims to vastly increase the availability of evidence-based psychological treatments for anxiety disorders and depression by training an extra 6,000 psychological therapists and deploying them in new, stepped care therapy services. Outcomes are assessed with a session-by-session monitoring system that achieves unusually high levels of data completeness. Around 600,000 patients per year are currently being seen in IAPT services. The background to the initiative, the scientific and economic arguments on which it is based, the training and clinical service models, a summary of progress to date, and future developments are described.

Psychological treatment of anxiety in primary care: a meta-analysis

Guidelines and mental healthcare models suggest the use of psychological treatment for anxiety disorders in primary care but systematic estimates of the effect sizes in primary care settings are lacking. The aim of this study was to examine the effectiveness of psychological therapies in primary care for anxiety disorders. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline, PsycINFO and Pubmed databases were searched in July 2010. Manuscripts describing psychological treatment for anxiety disorders/increased level of anxiety symptoms in primary care were included if the research design was a randomized controlled trial (RCT) and if the psychological treatment was compared with a control group. In total, 1343 abstracts were identified. Of these, 12 manuscripts described an RCT comparing psychological treatment for anxiety with a control group in primary care. The pooled standardized effect size (12 comparisons) for reduced symptoms of anxiety at post-intervention was d = 0.57 [95% confidence interval (CI) 0.29-0.84, p = 0.00, the number needed to treat (NNT) = 3.18]. Heterogeneity was significant among the studies (I 2 = 58.55, Q = 26.54, p < 0.01). The quality of studies was not optimal and missing aspects are summarized. We found a moderate effect size for the psychological treatment of anxiety disorders in primary care. Several aspects of the treatment are related to effect size. More studies are needed to evaluate the long-term effects given the chronicity and recurrent nature of anxiety.

Understanding and Treating Comorbid Anxiety Disorders in Substance Users

Anxiety disorders commonly occur among those with substance use disorders. This article reviews the literature describing the prevalence and patterns of this comorbidity in epidemiological and clinical samples and theoretical models explaining this comorbidity, and reviews the effects of anxiety disorders on substance use outcomes and data from clinical trials that target comorbid anxiety disorders to examine the effects of treating anxiety disorders on substance use outcomes. Next, this review outlines evidence-based pharmacological and psychological treatments for anxiety disorders and provides treatment recommendations for those treating this comorbid population. Finally, a discussion of treatment-delivery issues is presented to address the important issues that arise when treating anxiety disorders in typical addictions-treatment settings.

PTSD and Combat-Related Injuries: Functional Neuroanatomy

PTSD and Combat-Related Injuries: Functional Neuroanatomy

Short-term serotonergic but not noradrenergic antidepressant administration reduces attentional vigilance to threat in healthy volunteers

Anxiety is associated with threat-related biases in information processing such as heightened attentional vigilance to potential threat. Such biases are an important focus of psychological treatments for anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) are effective in the treatment of a range of anxiety disorders. The aim of this study was to assess the effect of an SSRI on the processing of threat in healthy volunteers. A selective noradrenergic reuptake inhibitor (SNRI), which is not generally used in the treatment of anxiety, was used as a contrast to assess the specificity of SSRI effects on threat processing. Forty-two healthy volunteers were randomly assigned to 7 d double-blind intervention with the SSRI citalopram (20 mg/d), the SNRI reboxetine (8 mg/d), or placebo. On the final day, attentional and interpretative bias to threat was assessed using the attentional probe and the homograph primed lexical decision tasks. Citalopram reduced attentional vigilance towards fearful faces but did not affect the interpretation of ambiguous homographs as threatening. Reboxetine had no significant effect on either of these measures. Citalopram reduces attentional orienting to threatening stimuli, which is potentially relevant to its clinical use in the treatment of anxiety disorders. This finding supports a growing literature suggesting that an important mechanism through which pharmacological agents may exert their effects on mood is by reversing the cognitive biases that characterize the disorders that they treat. Future studies are needed to clarify the neural mechanisms through which these effects on threat processing are mediated.

Mechanisms of exposure therapy: How neuroscience can improve psychological treatments for anxiety disorders

Exposure therapy for anxiety disorders has been one of success stories of clinical psychology and psychiatry. Nevertheless, a significant minority of patients fail to benefit from extant treatments. This clinical impasse is prompting renewed attempts to understand fear and its reduction at neural, cellular, and molecular as well as behavioral levels of analysis. The purpose of this article is to provide a review of theories of exposure therapy, including recent developments in emotional processing theory, and to discuss insights from neuroscience that promise to improve psychological treatments for reducing pathological fears.

Bridging the gap between biological and psychological perspectives in the treatment of anxiety disorders.

Presidential Address -- Allocution presidentielleAbstract. The applicability and usefulness of behavioural and cognitive treatment approaches for anxiety disorders is now well established. Various and different theoretical mechanisms have been proposed to explain their therapeutic effects on anxiety. Today's research suggests that psychological variables mediating change in behavioural and cognitive therapy for anxiety disorders are similar. Furthermore, effects of drug and psychological treatment for anxiety disorders appear to be mediated by same psychological and neurobiochemical variables. It is postulated that a better understanding of interaction between these variables will lead to new, significant advances in treatment of anxiety disorders.Some of our most prominent scholars think that anxiety serves a protective function. For others, it is at very root of what it means to be human. Still others believe that our very ability to adapt and plan for future depends on anxiety. Without denying potential advantages of being anxious, it is equally important to recognize that, for many individuals, anxiety is a curse something they could live without. In our society, individuals spend billions of dollars yearly to rid themselves of anxiety. More people visit their physician for anxiety than for coughs and colds.The aim of this paper is to provide an overview of research and theorizing about behavioural and cognitive treatment of anxiety and panic. It is also to discuss directions for future research.What Is Anxiety?The feelings of anxiety, worry, fear, and panic are quite universal and easy to recognize. Many individuals use these terms interchangeably (e.g., Clark, 1986; Rapee, 1996) while others believe that these terms have distinct meanings (e.g., Antony & Barlow, 1996).There are several definitions of anxiety in literature and it is beyond scope of this paper to review them. As far as Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) reflects a consensus among clinicians, one may refer to it for an acceptable definition. In DSM-IV, anxiety is defined as an apprehensive anticipation of future danger or misfortune accompanied by a feeling of dysphoria or somatic symptoms of tension. This definition implies that anxiety is a future-oriented state, functioning to motivate organism to behave in such a way that future danger is averted. Experiences of anxiety, however, can become overwhelming. When they do, anxiety disorders may develop.What Are Anxiety Disorders?The anxiety disorders are a group of psychological problems that affect behaviour, thoughts, feelings, and physical sensations. Their key features include excessive anxiety, fear, worry, and avoidance. The most prevalent anxiety disorders listed in DSM-IV (American Psychiatric Association, 1994) include panic disorder with and without agoraphobia (PDA and PD, respectively), social phobia, specific phobia, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). Other relevant disorders include acute stress disorder (similar to PTSD, except with a shorter duration), anxiety disorder due to a general medical condition, substance-induced anxiety disorder, agoraphobia without a history of panic disorder, and anxiety disorder not otherwise specified.Panic Disorder with and without Agoraphobia. The essential feature of PD and PDA is occurrence of recurrent unexpected attacks of panic (i.e., attacks coming out of thin air, in places where there is nothing to fear) about which there is persistent concern. Although generally lasting only a few minutes, panic attacks cause a person to feel as if he or she is having a heart attack, dying, or going crazy. They are often described as the most terrifying experience I've ever had. …

Psychological treatment for anxiety disorders: a review.

Psychological treatment for anxiety disorders: a review.