Beteendeterapi vid ångestneuros. En evaluerande översikt

Abstract

De olika kontrollerade gruppstudier och okontrollerade fallstudier som finns publicerade rörande beteendeterapeutiska metoder vid ångestneuros presenters och evalueras. Studierna har uppenbara brister vad gäller presentation av patientmaterialet, mätmetoderna och tillämpningen av vissa behandlingsmetoder. Resultaten visar i allmänhet på relativt små och sällan kliniskt signifikanta förbättringar. Artikeln avslutas med rekommendationer för fortsatt forskning framför allt rörande andra behandlingsmetoder än de hittills prövade.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

The effect of performance setting and individual differences on the anxiety-performance relationship for elite cyclists

Fifty-three national level cyclists completed competitive rides under both laboratory and field conditions to investigate the relationship between pre-competition anxiety and performance. A total of 39 males and 14 females participated in the study, ranging in age from 19 to 26. The objectives of the study were to, (a) measure the relationship between state anxiety and performance, (b) investigate differences in the anxiety-performance relationship under laboratory versus field conditions, and (c) examine the effect of trait anxiety on the state anxiety-performance relationship. State anxiety was measured using the Competitive State Anxiety Inventory-2 (CSAI-2; Martens, Vealey, & Burton, 1990), and trait anxiety with the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970). Results indicated that anxiety was strongly correlated with performance on the field test, but that the anxiety-performance relationship was weaker under laboratory conditions. Results also showed that trait anxiety interacted with the relationship, as low and high trait-anxious subjects had differential response patterns to pre-competition anxiety. The findings are discussed in terms of their relevance for both practitioners and researchers.     

Test anxiety and metacognitive skillfulness: Availability versus production deficiencies

Abstract

This paper focuses on the role of metacognition in test anxiety. In two experiments, the metacognitive skillfulness of high vs. low test-anxious secondary school students was contrasted. Low test-anxious subjects exhibited a superior metacognitive skillfulness during math performance relative to high test-anxious subjects. Furthermore, differences in metacognitive skillfulness were performance related. In order to unravel causality in the relation between metacognition and test anxiety, two types of test-anxious students may be distinguished analogous to Naveh-Benjamin (1991). Type-1 students would lack metacognitive skills (availability deficiency), through which they experience failure and develop test anxiety. Type-2 students would experience task irrelevant thoughts, which causes cognitive interference with available metacognitive skills (production deficiency). Results of Study 1 reveal that metacognitive cueing may represent an adequate method for the identification of both types. Due to time-constraints, metacognitive cueing in Study 2 failed to do so.     

LEARNED HELPLESSNESS ATTRIBUTIONAL STYLE AND EXAMINATION PERFORMANCE: ENHANCEMENT EFFECTS ARE NOT NECESSARILY MODERATED BY PRIOR FAILURE

Studies have replicated both negative and positive associations between helpless attributional style and academic performance. Laboratory studies indicate that when enhancement effects occur, they may be moderated by the degree of failure individuals experience prior to task performance. In a longitudinal study of 96 college students who completed four examinations in two introductory psychology courses, we examined the relationship between helpless attributional style and examination performance across the semester, and whether prior examination failure moderated this association. Correlational analyses revealed that helpless attributional style was unrelated to exam performance in the first half of the semester and was positively related to improvements in performance in the second half. Regression analyses indicated that these enhancement effects were not moderated by previous performance on examinations in the course. The present findings underscore the need for longitudinal studies that investigate the pattern of associations between helpless attributional style and performance across time in real-life contexts.     

Arousal interventions for athletic performance: Influence of mental preparation and competitive experience

Abstract

Mental preparation, or “psych-up” strategies have been assumed to promote physical arousal which subsequently improves certain athletic performances. The present experiment examined the role of arousal changes in the use of psych-up strategies on a physical strength task and a reaction time-decision task for subjects varying in competitive experience. Eighty-four subjects were reliably divided into high, moderate, or low competitive experience groups and randomly assigned to one of three mental preparation strategies. These strageies, which the subjects employed during a mental preparation period for both tasks, were either: (a) a self-generated arousal strategy, (b) a prescribed arousal strategy, or (c) a placebo-control strategy. While heart rate was being monitored, each subject completed a baseline trial, then one trial following a 45 sec mental preparation period and one trial following a 45 sec distraction interval. Order of presentation of tasks and order of presentation of distraction and mental preparation trials were counterbalanced and statistically analyzed. The results support the utility of different mental preparation strategies for increasing strength performance, but not reaction time-decision performance, for subjects with moderate and high levels of previous competitive experience. Self-generated arousal strategies enhanced performance of moderate experienced subjects. Analyses of the heart rate data failed to support the assumption that physiological arousal mediates the influence of psych-up strategies. Mental preparation strategies improved athletes' performance on certain tasks, however these strategies do not necessarily achieve their effects through increased autonomic arousal.     

Thought listing and endorsement measures of self-referential thinking in test anxiety

Abstract

The primary purpose of the present study was to examine cognitive reactions of high and low test-anxious subjects while performing a task of extreme difficulty. A sample of 44 subjects (28 females, 16 males) attempted a difficult analogies task and then reported their thoughts during the task. Subjects also completed the Sarason Test Anxiety Scale and several other self-report measures of their cognitive reactions to the task. Thought listings were classified according to their referent (self, task, or unrelated) and their valence (positive, negative, or neutral). Correlational analyses were then performed with the various measures and revealed an association between test anxiety and reports of negative thoughts involving the self. Test anxiety was not related significantly to the number of thoughts involving the task nor to actual performance on the task. However, test-anxious subjects did report more negative expectancies for their performance and greater cognitive interference during the task. Negative self-expectancies were also related to more negative self thoughts, fewer positive self thoughts, and fewer positive task-related thoughts. The results are interpreted as further evidence for both the role of negative self-related cognitions in the experience of test anxiety and the usefulness of unstructured measures in anxiety research.     

Effects of lifestyle and stress on the employee and organization: Implications for promoting health at work

Abstract

This research was designed to determine the extent to which employee health and performance are predicted by lifestyle and stress. Data were collected from 345 employees working in a variety of organizations in southern California. Additionally, supervisors evaluated the work performance of the participating employees whom they directly supervised, and company records of employee health care costs were obtained. Hierarchical multiple regression analyses revealed (a) that physical lifestyle (i.e., exercise pattern, eating habits, and general health practices) predicted unique variance in vitality and positive well-being; (b) that psychosocial lifestyle (i.e., social relations, intellectual activity, occupational conditions, and spiritual involvement) predicted unique variance in vitality, positive well-being, anxiety, depression, lack of self-control, and somatic complaints; (c) that employee stress predicted unique variance in vitality, positive well-being, anxiety, depression, physician visits, somatic complaints, illness absences, and supervisory ratings of job performance, absenteeism and tardiness; (d) that physical lifestyle buffered the adverse consequences of stress for anxiety, depression, physician visits, and company health care costs; and (e) that there was a Physical x Psychosocial Lifestyle interaction for anxiety, depression, and lack of self-control. However, the employee lifestyle factors were not related to supervisory ratings of performance at work. The findings have direct implications for organizational health programs and policies.     

From goal motivation to goal progress: the mediating role of coping in the Self-Concordance Model

Abstract

The present studies examined the mediating role of self-regulatory mechanisms in the relationship between goal motivation and goal progress in the Self-Concordance Model. First, a systematic review, using meta-analytical path analysis, supported the mediating role of effort and action planning in the positive association between autonomous goal motivation and goal progress. Second, results from two additional empirical studies, using structural equation modeling, lent credence to the mediating role of coping in the relationship between goal motivation and goal progress of university students. Autonomous goal motivation was positively associated with task-oriented coping, which predicted greater goal progress during midterm exams (Study 1, N=702) and at the end of the semester in a different sample (Study 2, N=167). Controlled goal motivation was associated with greater disengagement-oriented coping (Study 1 and Study 2) and lesser use of task-oriented coping (Study 2), which reduced goal progress. These results held up after controlling for perceived stress (Study 2). Our findings highlight the importance of coping in the “inception-to-attainment” goal process because autonomous goal motivation indirectly rather than directly predicts goal progress of university students through their usage of task-oriented coping.