Psychotherapy For Anxiety Disorders Research Articles

Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy

Anxiety disorders are widespread in the population and in general medical practice and have a pronounced negative impact on the quality of life and functioning of patients. Currently, the prerequisites for the diagnosis and treatment of anxiety disorders outside the psychiatric network are accumulating by therapists, general practitioners and other non-psychiatric doctors. A review of the most significant factors contributing to a wider diagnosis and treatment of anxiety disorders in general medical practice is given. This review presents modern ideas about the pathogenesis of anxiety disorders, substantiates the modern idea of their multifactorial nature, the contribution of genetic and epigenetic, psychological and social factors, outlines the concepts of the neurobiological basis of pathological anxiety based on neuroimaging studies. In the future, information is provided on the general manifestations of anxiety disorders, the main clusters of anxiety, the systematics of anxiety disorders according to ICD-10. Modern ideas about the diagnosis of anxiety disorders using both scales and a clinical approach are given, a detailed review of currently available diagnostic scales validated for clinical practice is presented. The main approaches to conducting a clinical conversation are also presented, recommendations are given for the most successful collection of information about the clinical condition of patients. At the end of the review, information is given on existing approaches to psychopharmacotherapy and psychotherapy of anxiety disorders. Taking into account pharmacological and clinical studies, the place of drugs tofisopam (an atypical allosteric modulator of GABA receptors) and buspirone (a partial agonist of serotonin 1A receptors) in the treatment of anxiety disorders in general medical practice has been argued.

Preliminary evidence for a Theory of Mind impairment in patients with Anxiety Disorders

IntroductionTheory of Mind is defined as the ability to understand mental states of other people, and is notoriously impaired in patients with Autism Spectrum Disorder. A growing body of evidence suggests an impairment of Theory of Mind in several other psychopathological disorders. However, only few studies have assessed Theory of Mind in patients with Anxiety Disorders (AD), addressing only patients with Social Anxiety Disorder.ObjectivesWe aimed to investigate the differences in Theory of Mind between patients with AD and Healthy Controls (HC).MethodsWe enrolled 35 patients admitted in the Psychiatric Unit of Careggi with diagnosis of AD and 31 HC. We administered them: Zung Anxiety Scale (ZSAS), Empathy Quotient (EQ), Reading the Mind in the Eyes (RMET), and Faux Pas test (FP). A t-test for independent samples was performed to assess between-group differences.ResultsZung total scores proved to be significantly higher in patients (t(60)=4.375, p<0.001), while Empathy Quotient total scores (t(61)=-3.325, p=0.002), detection of faux pas in Faux Pas test (t(61)=-4.957, p<0.001), RMET total scores (t(63)=-2.269, p=0.031) were significantly higher in healthy controls.ConclusionsSuch preliminary data suggest impairment of Theory of Mind and Empathy in patients with AD as compared to HC. This could be linked to the development and maintenance of anxiety symptoms in patients with AD, making Theory of Mind a potential target in psychotherapy of AD.DisclosureNo significant relationships.

Acceptability of an enhanced transdiagnostic CBT intervention for adults with anxiety disorders who are parenting an anxious child

ABSTRACT Objectives Anxiety disorders are highly prevalent in adults, and commonly aggregate within families. Although cognitive behavioural therapy (CBT) is regarded the most efficacious psychotherapy for anxiety disorders, remission rates are sub-optimal and broader systemic factors are typically not considered. The present study examined the acceptability of a modified transdiagnostic CBT for adult anxiety that also targeted anxiety-maintaining parenting behaviours and cognitions in anxious adults parenting an anxious child. Methods Ten anxious adults (M age = 39.5, SD = 2.9) parenting an anxious child (M age = 8.5, SD = 1.4) were interviewed. Five parents who received the intervention and five parents interested in the intervention provided retrospective and prospective perceptions of intervention acceptability, along with perspectives on bidirectional parent–child factors relevant to anxiety symptom maintenance. Responses were analysed using a reflexive thematic analysis. Results Six themes emerged showing the intervention was perceived as beneficial and effective for reducing parents’ own anxiety and managing bidirectional anxiety maintaining factors in the parent-child dyad. Conclusions Parents’ rich perspectives elucidate the aspects of the intervention that are important to this underrepresented population. Further, targeting an adult’s anxiety in a systemic context was valued by anxious adults parenting an anxious child, providing a rationale for broader evaluation. Trial prospectively registered, ANZCTR1261900033410, 04 March 2019.

Psychotherapy of anxiety disorders: state of the art

Alongside depression, anxiety disorders are the most frequent reason for consulting apsychotherapist. This article describes the recent progress in understanding basic learning processes in anxiety treatment, the resulting therapeutic procedures, the current state of knowledge on the efficacy of the various psychotherapeutic procedures and on the moderators of the success of treatment. The English and German language literature was reviewed and compiled, with an emphasis on the last 10years. Cognitive-behavioral therapy (CBT) achieves the best and broadest level of evidence across all anxiety disorders. Initial studies have also provided emerging evidence for the efficacy of manualized short-term psychodynamic treatment. The most discussed mechanism of action is that of inhibitory learning. Augmentation strategies and personalized treatment approaches are gaining in relevance. Current models of inhibitory learning are rooted in basic research and foster adeeper understanding of the underlying neurobiological mechanisms. In order to optimize success of exposure treatment in vulnerable subgroups of patients, many procedural, device-based and pharmacological augmentation strategies are currently under investigation, whereby the latter are mostly still in the stage of (pre)clinical testing.

Personality and anxiety disorders: examination of revised reinforcement sensitivity theory in clinical generalized anxiety disorder, social anxiety disorder, and panic disorder

BackgroundPersonality has been implicated in the development and continuation of mental disorders. One major advance in the personality field came with the reinforcement sensitivity theory (RST). The study of personality can help explicate the pathology of anxiety disorders. To this end, the present study compared the profile of the revised reinforcement sensitivity theory (r-RST) of personality in generalized anxiety disorder (GAD), social anxiety dis-order (SAD), and panic disorder (PD).Participants and procedureSeventy-eight GAD patients, 76 SAD patients, 72 PD patients, and 85 healthy individuals participated in the present study. All participants were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I), Beck Depression Inventory, Jackson-5 Questionnaire, Generalized Anxiety Disorder Questionnaire, Panic and Agoraphobia Scale, and Social Phobia Inventory. Ethical approval for this study was obtained from the Research Deputy of Kashan University of Medical Sciences. Participants were given information about the study and provided informed consent in writing.ResultsData were analyzed by chi-square, independent t-test, analysis of variance, and multivariate analysis of vari-ance. All patients were higher on Flight than the control group. Also, all patients and healthy controls differed in the revised reinforcement sensitivity theory.ConclusionsThe more nuanced knowledge from the revised reinforcement sensitivity theory may be helpful in the diagno-sis, etiology, and psychotherapy of anxiety disorders.

Optimizing Psychotherapy for Anxiety Disorders

Optimizing Psychotherapy for Anxiety Disorders

The effectiveness of three psychotherapies of different type and length in the treatment of patients suffering from anxiety disorder

IntroductionData on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.AimTo compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.MethodsAltogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.ResultsDuring the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.ConclusionsThe difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Perceived burdensomeness and suicide ideation in adult outpatients receiving exposure therapy for anxiety disorders

Perceived burdensomeness is considered a proximal risk factor for suicide ideation. However, there is a lack of prospective studies. Furthermore, it is unclear in as much psychotherapy for anxiety disorders is associated with a decrease in suicide ideation. A total of 105 adult outpatients suffering from panic disorder, agoraphobia, or specific phobia received manualized exposure-therapy. Perceived burdensomeness was considered as predictor of suicide ideation concurrently, after the fourth and the tenth therapy session and posttreatment – controlling for baseline symptom distress, suicide ideation, number of therapy sessions and age. Furthermore, pre-to post-changes in suicide ideation and perceived burdensomeness were assessed. Perceived burdensomeness emerged as a significant predictor of suicidal ideation concurrently and after the fourth and the tenth therapy session, but not at the end of therapy. Treatment had no effect on suicide ideation and only a marginal effect on perceptions of burdensomeness. In conclusion, the current study highlights the importance of perceptions of burdensomeness in understanding suicide ideation.

Cognitive Hypnotherapy for Accessing and Healing Emotional Injuries for Anxiety Disorders

Although anxiety disorders on the surface may appear simple, they often represent complex problems that are compounded by underlying factors. For these reasons, treatment of anxiety disorders should be individualized. This article describes cognitive hypnotherapy, an individual comprehensive treatment protocol that integrates cognitive, behavioral, mindfulness, psychodynamic, and hypnotic strategies in the management of anxiety disorders. The treatment approach is based on the self-wounds model of anxiety disorders, which provides the rationale for integrating diverse strategies in the psychotherapy for anxiety disorders. Due to its evidence-based and integrated nature, the psychotherapy described here provides accuracy, efficacy, and sophistication in the formulation and treatment of anxiety disorders. This model can be easily adapted to the understanding and treatment of other emotional disorders.

Effects of Psychotherapy on Brain Activation Patterns in Anxiety Disorders

Abstract. Psychotherapy is an effective treatment for most mental disorders, including anxiety disorders. Successful psychotherapy implies new learning experiences and therefore neural alterations. With the increasing availability of functional neuroimaging methods, it has become possible to investigate psychotherapeutically induced neuronal plasticity across the whole brain in controlled studies. However, the detectable effects strongly depend on neuroscientific methods, experimental paradigms, analytical strategies, and sample characteristics. This article summarizes the state of the art, discusses current theoretical and methodological issues, and suggests future directions of the research on the neurobiology of psychotherapy in anxiety disorders.

Psychodynamic Emotional Regulation in View of Wolpe's Desensitization Model.

The current research belongs to the stream of theoretical integration and establishes a theoretical platform for integrative psychotherapy in anxiety disorders. Qualitative metasynthesis procedures were applied to 40 peer-reviewed psychoanalytic articles involving emotional regulation. The concept of psychodynamic emotional regulation was found to be connected with the categories of desensitization, gradual exposure, containment, and transference. This article presents a model according to which psychoanalytic psychotherapy allows anxiety to be tolerated while following the core principles of systematic desensitization. It is shown that despite the antiresearch image of psychoanalytic psychotherapy, its foundations obey evidence-based principles. The findings imply that anxiety tolerance might be a key goal in which the cumulative wisdom of the different therapies can be used to optimize psychotherapy outcomes.

Functional neuroimaging of psychotherapeutic processes in anxiety and depression: from mechanisms to predictions.

The review provides an update of functional neuroimaging studies that identify neural processes underlying psychotherapy and predict outcomes following psychotherapeutic treatment in anxiety and depressive disorders. Following current developments in this field, studies were classified as 'mechanistic' or 'predictor' studies (i.e., informing neurobiological models about putative mechanisms versus aiming to provide predictive information). Mechanistic evidence points toward a dual-process model of psychotherapy in anxiety disorders with abnormally increased limbic activation being decreased, while prefrontal activity is increased. Partly overlapping findings are reported for depression, albeit with a stronger focus on prefrontal activation following treatment. No studies directly comparing neural pathways of psychotherapy between anxiety and depression were detected. Consensus is accumulating for an overarching role of the anterior cingulate cortex in modulating treatment response across disorders. When aiming to quantify clinical utility, the need for single-subject predictions is increasingly recognized and predictions based on machine learning approaches show high translational potential. Present findings encourage the search for predictors providing clinically meaningful information for single patients. However, independent validation as a crucial prerequisite for clinical use is still needed. Identifying nonresponders a priori creates the need for alternative treatment options that can be developed based on an improved understanding of those neural mechanisms underlying effective interventions.

MDMA for the treatment of mood disorder: all talk no substance?

Unipolar depression is the third highest contributor to the global burden of disease, yet current pharmacotherapies typically take about 6 weeks to have an effect. A rapid-onset agent is an attractive prospect, not only to alleviate symptoms before first-line antidepressants display therapeutic action, but as a further treatment option in nonresponsive cases. It has been suggested that 3,4-methylene-dioxymethamphetamine (MDMA) could play a part in the treatment of depression, either as a rapid-onset pharmacological agent or as an adjunct to psychotherapy. Whilst these hypotheses are in keeping with the monoamine theory of depression and the principles surrounding psychotherapy, explicit experimental evidence of an antidepressant effect of MDMA has rarely been established. To address the hypothesis surrounding MDMA as a rapid-onset antidepressant by examining pharmacological, psychological and behavioural studies. We consider whether this therapy could be safe by looking at the translation of neurotoxicity data from animals to humans. A literature review of the evidence supporting this hypothesis was performed. The pharmacology of MDMA offers a promising target as a rapid-onset agent and MDMA is currently being investigated for use in psychotherapy in anxiety disorders; translation from these studies for use in depression may be possible. However, experimental evidence and safety analysis are insufficient to confirm or reject this theory at present.

Obsessive-Compulsive Disorder cases with a Good Prognosis which Underwent CBT and Morita Therapy

Moritatherapy was found by Shoma Morita in 1919 in Japan and is psychotherapy for anxiety disorders based on Eastern psychology. 2 OCDcases were illustrated to which Inpatient Morita therapy was applied after the trial of Cognitive Behavioural therapy and showed a favourable progress. Case 1 rejected exposure. Although Case 2 engaged in Cognitive Behavioural therapy, it had a side effect that his obsession intensified. Case 1 could shorten her bathing time and engaged in occupation of taking care of animals. After Case 2 engaged in works with other patients, he could live with obsession and was aware of anger towards his parents. Morita therapy is effective for OCD patients who reject exposure and who are inclined to intellectualize their emotions.

EPA-0581 - Long-term integrative psychotherapy of anxiety disorders in mitral valve prolapse patients: the factors of mental health improvement

Introduction Mitral valve prolapse (MVP) is a common cardiac pathology. There are some cases of a reduction in the intensity of clinical symptoms after the courses of psychotherapy and anxiolitic treatment of MVP patients (Stavrakaki, et al., 1991; Scordo, 2007). Objectives To identify personality characteristics, emotional features and stress factors in MVP patients suffering anxiety disorders (AD). Aims To investigate the factors of mental health improvement under the long-term systemic integrative psychotherapy in MVP patients with AD. Methods During 15 years 14 MVP patients with AD attended integrative psychotherapy on request. Psychological and clinical examinations of the patients were made before and after psychotherapy courses. Psychological testing embraced the assessment of’quality of life’ indicators by VAS, DISS and the Ryff Scales (PWB) as well as anxiety level (Spilberger Scales), and the level of frustration tolerance (Rosenzweig test). The psychotherapy program consisted of the elements of CBT, Gestalt therapy, Interpersonal psychotherapy, and Psychodynamic Psychotherapy. Results 72,2% patients demonstrated valid improvements of QOL self-rating, reduction of anxiety level, and increasing of frustration tolerance after psychotherapy. Moreover, medical diagnostics showed a significant reduction in the depth of MVP. Positive dynamics was associated with development of personality reflection, his/her emotional experience recognition, with improved skills of self regulation, and growing awareness of actual needs, individual purposes and resources of personality. Conclusions The importance of personality reflection and working on traumatic experiences and personality problems to reveale inner resources; as well as extension of one's repertory of coping processes were specified as facilitating factors.

Age differences in treatment response to a collaborative care intervention for anxiety disorders

Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults. We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults. We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269). The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults. These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.

Brain Substratum Of Pathogenic Neurotic Belief In Panic Disorder: A Single Case Study

Abstract The aim of the study was to demonstrate how recent research achievements in the neuroscience of emotions can influence practical management of anxiety disorders. Using the data obtained from analysis of psychophysiological mechanisms in one case of panic disorder, the type of threat, key threat stimuli, and the structure of the pathogenic neurotic belief were ascertained and, on this basis, an individually tailored therapeutic procedure was designed. Its application resulted in almost complete dissipation of the neurotic belief, which represented the key p athogenic mechanism in the case studied. The study called attention especially to the importance of detailed diagnostics of memory mechanisms underlying the formation of neurotic belief in the psychotherapy of anxiety disorders.

Long-term social status and intimate relationship in women with childhood sexual abuse who got outpatient psychotherapy for anxiety disorder and depression

The aim of this paper was twofold: namely to examine current intimate relationships and social status of women with childhood sexual abuse (CSA) in the long term after outpatient psychotherapy, and to investigate the relative influence of CSA and family background risk factors (FBRF) on the indicators of this status. Fifty-six women with reported CSA and 56 without CSA, who had outpatient psychotherapy for anxiety disorders and/or depression, were personally examined 5 years after termination. Women with CSA had considerably greater sexual and mental health problems, but the same prevalence of partnerships, children and friends as the contrast. No differences were observed as to self-esteem, intimate bonds and physical quality of life. Sexual problems and low education were mainly explained by CSA, other measures by FBRF. Women treated with outpatient psychotherapy for anxiety disorders and depression had moderate problems at long-term follow-up, but more so for those women who hade been exposed to CSA.

Psychopharmacotherapy or psychotherapy of anxiety disorders — one year results

Psychopharmacotherapy or psychotherapy of anxiety disorders — one year results

Computerised clinical benefit-cost audit of mental health care II: Time input, costs, patient satisfaction

Data from a computerised clinical audit of behavioural psychotherapy in anxiety disorders allowed analysis of therapist time input, speed of clinical im provement, and patient satisfaction. Different clinicians varied greatly in how much tim e they spent per patient per com pleted episode, how much their patients improved per hour of therapist time, and how satisfied their patients were with care. Patient satisfaction was not tied tightly to amount or speed of improvement. Compared to outpatients, inpatients were more severe to start with, needed more therapist tim e to treat, and improved less per therapist hour spent. Most inpatients, however, were treated by less selected and less highly trained nurses. The audit approach described can answer central questions about care delivery once data are gathered from enough patients and therapists to make firm generalisations possible.