Relationship between response to graded exposure and marital satisfaction in agoraphobics

Agoraphobics who were satisfied in their marriage responded well to graded exposure and maintained their improvement to 3-months follow-up. Satisfaction with self and partner remained unchanged in patient and spouse. Agoraphobics who were dissatisfied with their marriage improved initially with graded exposure but later lost most of their gains and reported no change in general neurotic symptoms. Marital dissatisfaction also remained unchanged. Patients' dissatisfaction with their spouses, measured before therapy, predicted outcome in the sample as a whole.     

Evidence-based psychological treatments for late-life anxiety

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults.     

Recall bias for stimulus and response anxiety words in spider phobics

Abstract

Experiments on memory bias in patients with anxiety disorders have produced inconsistent results. It is suggested that results may depend on whether the words studied relate to anxiety-inducing stimulus features or to the anxiety response. It was predicted, following previous results, that phobic subjects would show diminished recall of stimulus words, but that recall of response words might be enhanced. In fact, for both stimulus and response words, phobics showed better recall of phobia-related words than of control words. The results are consistent with the hypothesis that phobic anxiety is associated with a bias towards recall of phobia-related words. However, it seems likely that phobic anxiety has several potentially conflicting effects on recall, and that this accounts for the inconsistent results in literature.     

Religion and anxiety treatments in primary care patients

Earlier data suggested that religious physicians are less likely to refer to a psychiatrist or psychologist. This follow-up study measures how religious beliefs affect anxiety treatments in primary care. We surveyed US primary care physicians and psychiatrists using a vignette of a patient with anxiety symptoms. Physicians were asked how likely they were to recommend antianxiety medication, see the patient for counseling, refer to a psychiatrist, refer to a psychologist or licensed counselor, encourage meaningful relationships and activities, and encourage involvement in religious community. We experimentally varied symptom severity, whether the patient was Christian or Jewish, and whether she attended religious services. Physician attendance at religious services was assessed in the survey. The response rate was 896 out of 1427 primary care physicians and 312 out of 487 psychiatrists. Religious physicians were more likely to promote religious resources. There was no statistically significant difference between physicians' recommendations for religious and nonreligious patients. There was no statistically significant difference in religious and nonreligious physicians' referrals to a psychologist, licensed counselor, or psychiatrist. Ultimately, we did not find a difference in religious and nonreligious physicians' support for mental health referrals, however, religious physicians were more likely to encourage using religious resources.     

Using aptitude measurements for the optimal assignment of subjects to treatments with and without mastery scores

For assigning subjects to treatments the point of intersection of within-group regression lines is ordinarily used as the critical point. This decision rule is critized and, for several utility functions and any number of treatments, replaced by optimal monotone, nonrandomized (Bayes) rules. Both treatments with and without mastery scores are considered. Moreover, the effect of unreliable criterion scores on the optimal decision rule is examined, and it is illustrated how qualitative information can be combined with aptitude measurements to improve treatment assignment decisions. Although the models in this paper are presented with special reference to the aptitude-treatment interaction problem in education, it is indicated that they apply to a variety of situations in which subjects are assigned to treatments on the basis of some predictor score, as long as there are no allocation quota considerations.     

Cognitive modification versus prolonged exposure in vivo: a comparison with agoraphobics as subjects.

Cognitive restructuring and prolonged exposure in vivo were compared in a cross-over design with 21 agoraphobics.Assessments were made at the beginning of treatment, at cross-over, at the end of treatment and at the follow-up one month later. Assessment were carried out by an independent observer (phobic anxiety and avoidance scales and anxious mood) and by the client (measurement in vivo, phobic anxiety and avoidance scales. FSS, ASES, SDS and 1-E scale). Prolonged exposure in vivo proved to be a definitely superior form of treatment to cognitive restructuring, as measured by the behavioral in vivo measurement and the phobic anxiety and avoidance scales.     

Cognitive bias in symptomatic and recovered agoraphobics

Symptomatic agoraphobics, recovered agoraphobics, and normal control subjects completed a series of sentence stems that had either ambiguous or unambiguous meanings, and had either a potentially threatening or a nonthreatening connotation. The written completions made by subjects to these stems were classified as indicating either a biased (i.e. threat-related) or unbiased interpretation of the meaning of the stem, and if a biased interpretation was made, whether the subject indicated efforts at adaptive coping with the perceived threat. Results indicated that symptomatic agoraphobics exhibited strong biases for interpreting information as threatening, relative to normal control subjects. Moreover, recovered agoraphobics resembled symptomatic agoraphobics more than normal control subjects, thus indicating that cognitive biases may persist following cessation of panic attacks and reductions in avoidance behavior. However, recovered agoraphobics also exhibited tendencies to cope adaptively with perceived threats whereas symptomatic agoraphobics did not.     

Parents' perceptions of pharmacological and cognitive-behavioral treatments for childhood anxiety disorders

Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for childhood anxiety disorders. This study examined how parents (N=71) seeking treatment for their child's anxiety disorder perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable, believable, and effective in the short- and long-term. Children's treatment history influenced parents' perceptions of pharmacotherapy, with parents of children with no treatment history perceiving medication treatment as less acceptable and believable than parents of children with a history of medication alone or in combination with behavior therapy. No effect of treatment history was found for perceptions of CBT. Significant positive correlations emerged between parents' perceived acceptance and believability for pharmacotherapy and child age and level of dysfunction due to their child's anxiety, respectively. The level of the child's anxiety was not significantly correlated with parents' perceptions of either CBT or pharmacotherapy. Our results suggest that parents of anxious children prefer CBT to medication for the treatment of their child's anxiety disorder. Directions for future research are discussed.     

State-trait anxiety and motocross performance

The prediction from state-trait theory that subjects low in anxiety will perform better than highly anxious subjects on a more difficult task was tested on a motocross competition. We analyzed the relationships among the entire rank order of finish and state and trait anxiety measured by State-Trait Anxiety Inventory for 32 motocross riders (males whose age ranged from 16 to 27 yr.) participating in a national competition in Italy. A negative correlation between performance (measured by rank at the finish of the competition) and state anxiety was noted. The r for state and trait anxiety scores was also negative, but that between performance and trait anxiety was nonsignificant. Additional studies of high level sport competition will provide data relevant to planning interventions to control athletes' anxiety.     

Overview of diagnosis and drug treatments of anxiety disorders

Anxiety disorders are common and often disabling. They fall into five main categories: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and posttraumatic stress disorder, each of which have characteristic symptoms and cognitions. All anxiety disorders respond to drugs and psychological treatments. This review will focus on drug treatments. Recent research has emphasized the value of antidepressants especially the selective serotonin reuptake inhibitors, benzodiazepines, and related sedative-like compounds. The common co-existence of depression with all of the anxiety disorders means that the selective serotonin reuptake inhibitors are now generally considered to be the first-line treatments but the benzodiazepines have some utility especially in promoting sleep and working acutely to reduce extreme distress.