Efficacy of a cognitive-behavioural therapy administered by videoconference for generalized anxiety disorder

IntroductionDelivering psychotherapy by videoconference could considerably extend the accessibility of empirically validated treatments.ObjectiveThe aim of this study was to evaluate the efficacy of a cognitive-behavioural therapy (CBT) for generalized anxiety disorder (GAD), administered via videoconference.MethodFive participants with a primary diagnosis of GAD took part in an experimental multiple baseline case study protocol. The efficacy of the treatment was evaluated using a semi-structured interview, self-report questionnaires, and daily self-monitoring diaries.ResultsThe results demonstrate that overall, participants’ conditions were improved following treatment and they no longer met the diagnostic criteria for GAD in the short-term. Participants’ conditions improved clinically and statistically at each follow-up point, achieving a greater global level of functioning at post-test, as well as at 3-month and 12-month follow-up.ConclusionClinical implications of this new treatment modality and directions for future research are discussed.     

Money talks in attention bias modification: Reward in a dot-probe task affects attentional biases

Attention bias modification (ABM) aimed at correcting dysfunctional biases in anxiety patients has met with only mild success. Inspired by recent studies showing large effects of financial reward upon attention shifts, we contrasted effects of traditional dot-probe ABM and reward upon attention biases in a between-subject 2 × 2 design. Twenty-seven participants in group cognitive behavioural therapy (GCBT) for social anxiety disorder (SAD) were randomly assigned to undergo six sessions of a dot-probe task consisting of ABM or placebo ABM along with random or high reward following neutral stimuli. There was no influence of ABM on participants' attention bias over and above the influence of GCBT. Reward, however, had a strong influence on attention bias. Neither ABM nor reward reduced SAD symptoms over and above the effects of GCBT. The results add to the growing evidence that benefits of ABM through dot-probe training are unreliable but suggest on the other hand that rewarding attention may strongly influence dysfunctional attention biases.     

The relationship between ADHD symptoms and driving behavior in college students: The mediating effects of negative emotions and emotion control

Previous research has shown a relationship between attention deficit-hyperactivity disorder (ADHD) symptoms and driving anger and adverse driving outcomes. Moreover, adults with ADHD symptoms express their emotions in more aggressive ways, indicating a lack of emotion control. The present study surveyed 246 college students to examine the relationship among ADHD symptoms, negative emotions, emotion control, and driving anger and safe driving behavior. Mediating effects of negative emotions and emotional control on the relationship between ADHD symptoms and self-reported driving anger and safe driving behavior were also examined. Both negative emotions and emotion control were significant mediators of the relationship between ADHD symptoms and driving anger, but not safe driving behavior. Mediation was stronger for ADHD-Hyperactive/Impulsive symptoms than for ADHD-Inattention symptoms. These results may provide some insight on how to design training programs for individuals with ADHD symptoms to increase driving safety.     

The lived experiences of individuals with Tourette syndrome or tic disorders: A meta‐synthesis of qualitative studies

There is a growing body of qualitative literature describing the lived experiences of people with tic disorders (TDs). The aim of this paper was to conduct a systematic review of this literature, synthesizing the perspectives of individuals on their experiences. Meta‐synthesis methodology was utilized to review and draw together findings from 10 articles, from which key concepts were extracted, and over‐arching themes generated. Six themes were identified to encompass the experience of TDs, including (1) cultural, semantic issues of the condition; (2) negative experiences in organizations and treatment; (3) the value and negative impact on interpersonal relationships; (4) personal identity in the constant presence of TDs; (5) concerns for the future; and (6) strategies to control and manage the observable presence of tics. Adaptive coping strategies were found to encompass continuous social adaptation, strategies to manage tics and social perceptions, self‐acceptance, advocacy, and support from others. The results highlighted the significant role of social and cultural issues related to understanding and stigma, which underpinned many of the lived experiences. Implications for clinical practice in supporting individuals with TDs were also highlighted.     

Co-occurring motor,language and emotional–behavioral problems in children 3–6 years of age

PurposeDevelopmental Coordination Disorder (DCD) has been shown to co-occur with behavioral and language problems in school-aged children, but little is known as to when these problems begin to emerge, or if they are inherent in children with DCD. The purpose of this study was to determine if deficits in language and emotional–behavioral problems are apparent in preschool-aged children with movement difficulties.MethodTwo hundred and fourteen children (mean age 4 years 11 months, SD 9.8 months, 103 male) performed the Movement Assessment Battery for Children 2nd Edition (MABC-2). Children falling at or below the 16th percentile were classified as being at risk for movement difficulties (MD risk). Auditory comprehension and expressive communication were examined using the Preschool Language Scales 4th Edition (PLS-4). Parent-reported emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL).ResultsPreschool children with diminished motor coordination (n = 37) were found to have lower language scores, higher externalizing behaviors in the form of increased aggression, as well as increased withdrawn and other behavior symptoms compared with their typically developing peers.ConclusionsMotor coordination, language and emotional–behavioral difficulties tend to co-occur in young children aged 3–6 years. These results highlight the need for early intervention.     

Exercise can improve physical self perceptions in adolescents with low motor competence

Adolescents with low motor competence have diminished perceptions of their physical self and tend to avoid physical activities. This study examined the outcomes of an exercise intervention that focused on improving aerobic fitness, strength, and self-perceptions in the physical domain in adolescents with poor motor coordination. The sample included 35 adolescents with low motor competence, comprising boys (n = 25) and girls (n = 10) ranging in age from 13 to 17 years, who attended two sessions per week in the 13 week exercise intervention study (AMP it up). Physical self-perceptions were measured before and after the intervention using the Physical Self Perception Profile and Perceived Importance Profile. Significant improvements in perceived Physical Condition, Attractive Body and Physical Strength sub domain scores were identified between pre and post-test. Adjusting for age, gender, BMI and attendance, regression analyses revealed that Attractive Body was the strongest predictor of Physical Self Worth at pre-test, joined by Physical Condition at post-test. This exercise intervention had a positive impact on adolescent physical self-perceptions, in particular males, with improvements in those sub domains specifically related to the exercise program. Changes in specific aspects of Physical Self Worth can be facilitated by exercise interventions, after a relatively short period of time, in adolescents with poor motor coordination.     

Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) continues to challenge professionals due to symptom severity, co-morbidity, suicidal ideation, and overvalued ideation. Despite the disorder's severity, little research exists. Clinical observation suggests a noteworthy history of abuse; therefore the present study investigated the reported rate of physical, sexual, and emotional abuse in BDD patients. OCD patients were chosen as a comparison group because BDD is considered to be an obsessive-compulsive spectrum disorder. A group survey design was used (N = 50 for each group). Results show significantly higher levels of emotional and sexual abuse in the BDD sample versus the OCD sample. No significant differences were found in physical abuse. Abuse may be a contributing factor in BDD, but not in OCD.     

Cognitive inhibition and interference in dissociative identity disorder: the effects of anxiety on specific executive functions

Using an experimentally based, computer-presented task, this study assessed cognitive inhibition and interference in individuals from the dissociative identity disorder (DID; n=12), generalized anxiety disorder (GAD; n=12) and non-clinical (n=12) populations. Participants were assessed in a neutral and emotionally negative (anxiety provoking) context, manipulated by experimental instructions and word stimuli. The DID sample displayed effective cognitive inhibition in the neutral but not the anxious context. The GAD sample displayed the opposite findings. However, the interaction between group and context failed to reach significance. There was no indication of an attentional bias to non-schema specific negative words in any sample. Results are discussed in terms of the potential benefit of weakened cognitive inhibition during anxious arousal in dissociative individuals.     

Symptom patterns in children and adolescents with obsessive-compulsive disorder (OCD)

OBJECTIVE: Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms. The present study examines symptom patterns in OCD in children and adolescents in order to search for the presence of diagnostic heterogeneity. SUBJECTS AND METHODS: Two hundred and thirteen outpatients with primary OCD participated. The patients' and primary caretakers' responses on the Children's Yale-Brown Obsessive-Compulsive Scale were used to generate severity ratings for 61 OCD symptoms, and cluster analysed them. RESULTS: A five cluster solution was judged to be the most clinically and theoretically relevant model. The clusters were named: (1) "Mental Rituals, Touching & Ordering", (2) "Contamination & Cleaning", (3) "Superstitions", (4) "Obsessions/Checking & Confessing" and (5) "Somatic Concerns". The symptom patterns of the groups differed, and three groups were particularly homogeneous. In addition, there were differences in severity, number of symptoms and age. CONCLUSIONS: OCD in children and adolescents is a heterogeneous disorder and discrepancies vis-à-vis adult studies indicate that childhood OCD may have developmentally specific traits. The sub-groups obtained are likely to have implications for the assessment of OCD symptoms in children, their prognosis and outcome in treatment research.     

Effectiveness of dialectical behaviour therapy for borderline personality disorder in an inpatient setting

This study evaluates the effectiveness of dialectical behaviour therapy (DBT) for borderline personality disorder (BPD) in an unselected, comorbid population seeking 3-month inpatient treatment. We studied 50 consecutively admitted individuals (44 women, six men) with BPD as defined by DSM-IV at three time points (at admission, at discharge, and at the 15-month follow-up). For the clinical diagnoses, we used the Structured Clinical Interview for DSM-IV (SCID) and compared the frequencies of comorbid axis I and axis II disorders at admission and at the 15-month follow-up. Overall, participants showed a high degree of comorbidity. Psychopathology was significantly reduced at post-treatment and at follow-up. Effect sizes for outcome measures were within the range of those of previous studies. Our findings support the notion that the results of the DBT efficacy research can be generalized to an inpatient setting and to patients with BPD disorder with high comorbidity.