Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.     

Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.     

Divergent, criterion-related, and discriminant validities for the Kuwait University Anxiety Scale

Three analyses were carried out. Analysis I estimated the correlation between the total score of the Kuwait University Anxiety Scale and a self-rating scale of happiness with large sample of male (n = 1,312) and female (n = 1,272) Kuwaiti adolescents. Pearson product-moment correlations were -.43 and -.44 (p < .001) for boys and girls, respectively, suggesting divergent validity of the anxiety scale. Analysis II examined the correlations between scores on the Kuwait University Anxiety Scale and the Somatic Symptoms Inventory for a nonclinical sample of women (n = 30), and female outpatients with anxiety disorder (n = 30). Pearson product-moment correlations were, respectively, .85 and .53, (p < .001), which support the criterion-related validity of the Kuwait University Anxiety Scale with respect to the Somatic Symptoms Inventory. In Analysis III a sample of 60 male and female outpatients with anxiety disorder and 60 nonclinical participants were matched on age, education, and occupation. All responded individually to the Kuwait University Anxiety Scale. Significant differences among groups, especially noticeable for men, support the discriminant validity of the scale. So, the clinical as well as research use of the scale can be recommended. By and large, the divergent, discriminant, and criterion-related validities of the scale have been adequately supported so subsequent replication is expected.     

Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists’ evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients’ suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients’ attachment representations influence a psychologist’s evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discussed.     

Anxiety within families: interrelations, consistency, and change

In a community sample of mothers (N = 763), each with a focal child aged 4.5 years, anxiety levels were high. Only 54% of mothers had anxiety scores within the "normal" Hospital Anxiety and Depression Scale (HADS) range, compared with 85% for depression. A subsample (N = 116) was selected for two-parent families, one to three children, and mothers spread over low, medium, and high anxiety levels. Mothers' anxiety was not significantly related to age, education, or work status, but rather to mothers' and fathers' independent ratings of marital satisfaction and family functioning, and to fathers' own anxiety and depression. Fathers' anxiety was related not to their own views of marital satisfaction and family functioning, but rather to mothers' views and to maternal anxiety. Assessments 8 years later--of anxiety, depression, and family functioning--showed high consistency over time, particularly maternal anxiety (r = .70) and paternal depression (r = .81). Although means did not change significantly over time for fathers, mothers' anxiety, depression, and perceptions of family functioning all improved (p < .001). For parents who were later to separate (compared with the others), initial family functioning, dyadic adjustment, and maternal anxiety were significantly "worse." The strongest predictor of later break-up was fathers' dyadic adjustment.     

Locus of control,anxiety, and depression in infertile patients

This study aimed to examine the relationship of locus of control (LoC) with anxiety and depression disorders, applying multivariate statistical techniques to control for the effects of demographic/fertility variables. This cross-sectional study included 312 infertile patients in a referral fertility center in Tehran, Iran via convenience sampling. The Hospital Anxiety and Depression Scale and the Levenson’s Locus of Control Scale were administered to all participants. Hierarchical multiple linear regressions were used to identify factors associated with anxiety and depression. After controlling for demographic/fertility variables, hierarchical regression analyses showed that internal LoC was negatively associated with anxiety (β = –.213, p < .001) and depression (β = –.269, p < .001). Powerful others subscale was positively associated with anxiety (β = .176, p < .001), but there was no significant relationship between this subscale and depression (β = .047, p = .467). The findings of this study merit the understanding of the role of demographic/fertility characteristics and LoC orientations in anxiety and depression of infertile patients to identify beforehand those patients who might be at risk of experiencing high anxiety and depression and in need of support.     

Which Symptoms of Depression and Anxiety Matter Most? An Investigation of Subjective Importance Ratings With College Students in India

One goal of clinical psychological science is to help people with problems that matter to them. However, little is known about which kinds of symptoms are viewed as most important, particularly among individuals in non-western settings. We examined the extent to which young adults in India rated individual symptoms of depression and anxiety as important, concerning, and undesirable. Participants were college students at Indian Universities (n = 283). They received a measure of depressive symptoms (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder Screener-7). For each of the 16 symptoms, they provided three judgments relating to the extent to which they found the symptom important, harmful, and undesirable. These judgments were averaged to form a “subjective importance rating” (SIR) for each symptom. Anxiety symptoms were viewed as more important than depressive symptoms (d = 0.34), and nonsomatic symptoms were viewed as more important than somatic symptoms (d = 0.83). Females rated symptoms as more important than males (d = 0.32), and individuals with higher self-reported symptoms rated symptoms as more important. Sad mood, suicidal ideation, and controlling worries were rated as the most important symptoms, whereas concentration problems, appetite problems, and psychomotor problems were rated as the least important. Overall, some symptoms are viewed as more important and concerning than others. We discuss how this understanding can affect our conceptualization, assessment, and treatment of mental disorders around the world.     

Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial

Disorder-specific cognitive behavioural therapy programs delivered over the internet (iCBT) with clinician guidance are effective at treating specific anxiety disorders and depression. The present study examined the efficacy of a transdiagnostic iCBT protocol to treat three anxiety disorders and/or depression within the same program (the Wellbeing Program). Seventy-seven individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder, and/or social phobia were randomly assigned to a Treatment or Waitlist Control group. Treatment consisted of CBT-based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. Eighty one percent of Treatment group participants completed all 8 lessons within the 10 week program. Post-treatment data were collected from 34/37 Treatment group and 35/37 Control group participants, and 3-month follow-up data were collected from 32/37 Treatment group participants. Relative to Controls, Treatment group participants reported significantly reduced symptoms of anxiety and depression as measured by the Depression Anxiety and Stress Scales-21 item, Patient Health Questionnaire-9 item, and Generalised Anxiety Disorder-7 item scales, with corresponding between-groups effect sizes (Cohen’s d) at post treatment of.56,.58, and.52, respectively. The clinician spent a mean time of 84.76 min (SD = 50.37) per person over the program. Participants rated the procedure as highly acceptable, and gains were sustained at follow-up. These results provide preliminary support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders.     

The dermatology life quality index (DLQI) and the hospital anxiety and depression (HADS) in Chinese rosacea patients

The study aims to investigate the quality of life (QOL) and the psychological situation in Chinese patients with rosacea. A total of 196 healthy controls and 201 rosacea patients were involved in the final analysis. The general information, the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS) were collected. Significantly higher DLQI, anxiety and depression score were observed in the rosacea group compared to the control group (p < .01). Total DLQI score of patients was positively related with anxiety (r = .526, p < .001) and depression scores (r = .399, p < .001) in HADS. Rosacea had significant psychological impact on Chinese patients and had substantial influence on their QOL. Physicians should address the psychosocial needs of rosacea patients as much as its physical symptoms.     

The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women

The object was to assess anxiety and depression during in vitro fertilisation (IVF) treatment and determine IVF-related psychological factors in infertile Chinese women. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate anxiety and depression among 842 patients, respectively. A univariate analysis was used to compare variables among three SAS groups and three SDS groups. Anxiety and depression were both represented in 21.3% of the cases. Patients <35 years tended to be more anxious. In women <35 years, the SDS scores were higher with lower educational backgrounds and female or couple’s infertility, while the SAS scores were higher in female or couple’s infertility. In older ones, the SDS scores were higher in those with lower educational backgrounds and longer time for infertility, while the SAS scores were higher in those with lower educational backgrounds. In SAS groups 1–3, the embryo availability was 5.0 (3.0–8.0), 5.0 (3.0–8.0), and 3.0 (2.0–4.5) (p = .013); and the fertilisation rate was 91.9, 90.4, and 81.8% (p < .001), respectively. We concluded that infertile women experience anxiety and depression during IVF treatment, especially in women <35 years. Younger women with female infertility would be more anxious and depressive while higher education can protect them from depression. In older ones, they would experience more depressive with longer time for infertility and be less anxious and depressive with higher education. Anxiety affects the fertilisation rate and embryo availability.     

An open trial of a brief transdiagnostic internet treatment for anxiety and depression

The present study evaluated the efficacy of a brief version of an internet-administered transdiagnostic CBT protocol, the Wellbeing Program (Titov et al., 2011), designed to treat three anxiety disorders and major depression within the same program. This brief version included the same core CBT skills as the original, but condensed the materials from 8 to 5 online lessons, reduced the duration of treatment from 10 to 8 weeks and did not include an online forum. Thirty-two individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder or social phobia received CBT-based online educational lessons, homework assignments, weekly contact from a clinical psychologist and automated emails. Eighty-one percent of participants completed the lessons within the 8 week program. Post-treatment and 3-month follow-up data were collected from 28/32 and 31/32 participants respectively. Participants improved significantly on the Depression Anxiety and Stress Scales – 21 Item, Patient Health Questionnaire – 9 Item, and Generalised Anxiety Disorder – 7 Item scales, with corresponding within-group effect sizes (Cohen’s d) at follow-up of 1.05, .73, and .95, respectively. Participants rated the procedure as highly acceptable with gains of a similar magnitude as those found for the original program, but less time was spent per participant by the clinician in the present trial (mean = 44.61 min, SD = 34.45) compared to the original program (mean = 84.76 min, SD = 50.37). These results provide additional support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders and indicate that a brief version may be of benefit.     

Symptoms of anxiety disorders and teacher-reported school functioning of normal children

Correlations between scores on the Spence Children's Anxiety Scale, a questionnaire for measuring symptoms of anxiety disorders and a report of school functioning by teachers were computed for 317 primary school children and 13 teachers in The Netherlands. Analysis showed a small but significant negative correlation between scores for total anxiety and school functioning (r = -.20, p < .001). The finding is consistent with the notion that high symptoms indicating anxiety disorders in children are accompanied by less optimal functioning in school.     

Effect of static visual acuity on dynamic visual acuity: a pilot study

The aim of this pilot study was to evaluate whether dynamic visual acuity changes with or without refractive correction. 42 healthy enrolled subjects with normal vision were divided into two age-matched groups. In Group A, dynamic visual acuity was measured first with the refractive error fully corrected and then without. In Group B, dynamic visual acuity measurements were taken in the reverse order of that performed by Group A. The measurements were binocularly performed five times using free-head viewing after dynamic visual acuity values were stable. Significant changes in dynamic visual acuity (static visual acuity 20/20 vs 12/20) were observed in both Group A (171.6 +/- 36.0 deg./sec. vs 151.8 +/- 39.6 deg./sec., Wilcoxon test, p < .001) and Group B (169.8 +/- 30.0 deg./sec. vs 151.2 +/- 36.0 deg./sec., Wilcoxon test, p < .001). The interaction was significant (F1.20 = 8.12, p = .009). These results indicated that refractive correction affected dynamic visual acuity.     

Effects of cancer rehabilitation on problem-solving, anxiety and depression: a RCT comparing physical and cognitive-behavioural training versus physical training

We tested the effects on problem-solving, anxiety and depression of 12-week group-based self-management cancer rehabilitation, combining comprehensive physical training (PT) and cognitive-behavioural problem-solving training (CBT), compared with PT. We expected that PT + CBT would outperform PT in improvements in problem-solving (Social Problem-Solving Inventory-Revised (SPSI-R)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and that more anxious and/or depressed participants would benefit most from adding CBT to PT. Cancer survivors (aged 48.8 ± 10.9 years, all cancer types, medical treatment completed) were randomly assigned to PT + CBT (n = 76) or PT (n = 71). Measurement occasions were: before and post-rehabilitation (12 weeks), 3- and 9-month follow-up. A non-randomised usual care comparison group (UCC) (n = 62) was measured at baseline and after 12 weeks. Longitudinal intention-to-treat analyses showed no differential pattern in change between PT + CBT and PT. Post-rehabilitation, participants in PT and PT + CBT reported within-group improvements in problem-solving (negative problem orientation; p < 0.01), anxiety (p < 0.001) and depression (p < 0.001), which were maintained at 3- and 9-month follow-up (p < 0.05). Compared with UCC post-rehabilitation, PT and PT + CBT only improved in anxiety (p < 0.05). CBT did not add to the effects of PT and had no extra benefits for higher distressed participants. PT was feasible and sufficient for durably reducing cancer survivors' anxiety.     

运动员咀嚼口香糖行为与竞赛焦虑的关系

为考察运动员咀嚼口香糖行为与竞赛焦虑的关系,本研究采用自编《咀嚼口香糖与竞赛焦虑问卷CGSCA》与《运动竞赛焦虑测验SCAT》,调查了457名运动员。结果发现,SCAT表明,运动员在竞赛情景下普遍处于应激状态并容易体验到焦虑;CGSCA表明,竞赛咀嚼行为与竞赛焦虑存在显著正相关,竞赛焦虑高的个体拥有更多的竞赛咀嚼行为,并更多地采用咀嚼口香糖的方式来缓解竞赛焦虑。本研究表明,咀嚼口香糖可以缓解运动员的竞赛焦虑。     

The Effects of Affect Manipulation and Information Exposure on Divergent Thinking

This study examined how affective states and exposure to diverse information influence figural divergent thinking using a pretest-posttest design. A total of 148 participants were divided into 4 conditions: positive affect, negative affect, information, and control. In the positive and negative affect conditions, participants respectively listened to the elation and depression statements of the Velten procedure. In the information condition, participants listened to the neutral statements of the Velten procedure. In the control condition, participants listened to word-processing instructions. Divergent thinking was measured using the figural form of the Torrance Tests of Creative Thinking (TTCT), and affect was measured using a mood questionnaire and the State-Trait Anxiety Inventory. Multivariate analyses of covariance were conducted using the TTCT, mood, and state-trait anxiety premeasures as covariates; the TTCT, mood, and state-trait anxiety postmeasures as the dependent variables; and treatment condition as the independent variable. Results showed a significant effect of condition on posttreatment TTCT scores, F(3, 140) = 3.37, p = .0203; mood, F(3, 140) = 7.44, p = .0001; and state anxiety, F(3, 140) = 6.27, p = .0005. Comparison tests showed that the information exposure treatment resulted in significantly higher TTCT scores than the control condition, indicating that exposure to diverse information can enhance divergent thinking. Results further indicated that, although the positive affect manipulation was effective in enhancing mood and reducing state anxiety, it did not enhance divergent thinking scores. The negative affect manipulation did not appear to be effective. Possible explanations for these results are discussed.     

Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms

The purpose of the present study was to examine the potential efficacy, patient acceptability, and feasibility of a novel, cognitive-behavioral therapy (CBT) for adults with attention-deficit hyperactivity disorder (ADHD) who have been stabilized on medications but still show clinically significant symptoms. Thirty-one adults with ADHD and stable psychopharmacology for ADHD were randomized to CBT plus continued psychopharmacology or continued psychopharmacology alone. Assessments included ADHD severity and associated anxiety and depression rated by an independent evaluator (IE) and by self-report. At the outcome assessment, those who were randomized to CBT had lower IE-rated ADHD symptoms (p < .01) and global severity (p < .002), as well as self-reported ADHD symptoms (p < .0001) than those randomized to continued psychopharmacology alone. Those in the CBT group also had lower IE-rated and self-report anxiety (p's < .04), lower IE-rated depression (p < .01), and a trend to have lower self-reported depression (p = .06). CBT continued to show superiority over continued psychopharmacology alone when statistically controlling levels of depression in analyses of core ADHD symptoms. There were significantly more treatment responders among patients who received CBT (56%) compared to those who did not (13%) (p < .02). These data support the hypothesis that CBT for adults with ADHD with residual symptoms is a feasible, acceptable, and potentially efficacious next-step treatment approach, worthy of further testing.     

Unemployment, coping and psychological distress

This study addressed the role of coping sytle in anxiety and depression of unemployed people. Two-hundred thirty-three people checking in at unemployment services participated. They filled in Carver, Scheier and Weintraub's (1989) coping measure (COPE), the Hospital Anxiety and Depression scale (HAD), gave information as to age, duration of unemployment and their appraisal of their situation. Four secondary dimensions of COPE were used in data analyses. Multiple regression analyses were undertaken with anxiety/depression as dependent and the coping variables as independent variables, with background/appraisal variables entered first. Coping variables added to the prediction of anxiety and depression over and above background/appraisal variables. For women Focus on Emotion coping as well as Avoidance was related to higher anxiety/depression scores ( p <0.01), whereas Reappraisal was related to lower anxiety/depression ( p <0.05). For men only Avoidance was related to anxiety/depression ( p <0.01). More Avoidance co-occurred with higher levels of anxiety as well as depression. The results are discussed with respect to possible intervention.