Injection anxiety remains a long-term barrier to medication adherence in multiple sclerosis.

Objective: To evaluate the contribution of injection anxiety to disease modifying therapy (DMT) adherence among individuals with multiple sclerosis (MS). Injection anxiety has been associated with medication discontinuation early in the course of treatment, but little is known about the relationship between injection anxiety and sustained DMT adherence over time. Method: Eighty-nine outpatients receiving care at a Veterans Administration MS clinic completed a telephone survey at baseline and monthly telephone follow-up for 6 months. Results: Participants were established DMT users (M = 3.43 years, SD = 3.29), with relatively high adherence overall (over 80% achieved 80% adherence or greater). Using logistic regression and controlling for demographics, MS disability, type of DMT, and time on DMT, the authors found that baseline injection anxiety predicted lower levels of adherence at 4 months and 6 months, with a similar trend at 2 months. Conclusion: Sustained adherence to DMT remains a challenge for a subset of individuals with MS well beyond the initial period of acclimation. Injection anxiety is an important and promising target of psychological intervention during all periods of medication use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression.

Objective: While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. Design: MS patients (N = 127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. Main Outcome Measures: Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. Results: Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. Conclusion: Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis.

This study compared the efficacy of 3 16-week treatments for depression in 63 patients with multiple sclerosis (MS) and major depressive disorder (MDD): individual cognitive- behavioral therapy (CBT), supportive expressive group therapy (SEG), and the antidepressant sertraline. Significant reductions were seen from pre- to posttreatment in all measures of depression. Intent-to-treat and completers analyses using the Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward, M. Medelson, J. Mock, & J. Erbaugh, 1961) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression. These results were largely supported by the BDI-18, which eliminates BDI items confounded with MS. However, the Hamilton Rating Scale for Depression (M. Hamilton, 1960) did not show consistent differences between treatments. Reasons for this inconsistency are discussed. These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

For suicidal young adults with comorbid depressive and anxiety disorders, probem-solving treatment may be better than treatment as usual.

Practicing psychologists face many complexities and challenges in caring for suicidal patients who have comorbid mood and anxiety disorders. Not only must suicidal crises be addressed, but co-occurring depressive and anxiety symptoms compete for attention as well and are associated with relatively poor clinical prognosis in usual treatments. The current study compared problem-solving treatment to treatment as usual among depression–anxiety comorbid versus noncomorbid clinically suicidal young adults. Suicidal patients with mood and anxiety disorders were randomized to the 2 treatments and followed over time. Comorbid suicidal patients, in particular, experienced notable symptom improvements from the problem-solving treatment. Features of the problem-solving treatment are described for use in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of self-administered treatments for depression and anxiety.

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies. The results show large effects for SATs when compared with no-treatment control groups (d=1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d=-0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal analysis of cognitive dysfunction, coping, and depression in multiple sclerosis.

Using a longitudinal design, the authors examined coping and cognitive functioning in the development of depression in individuals with multiple sclerosis (MS). Coping style was evaluated in 2 conceptually distinct roles: as moderator and mediator of the impact of cognitive dysfunction on depression. Using indices derived from the COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989), the authors operationalized coping in 3 ways—as active, avoidant, and an index accounting for relative levels of both. Coping both moderated and partially mediated the relationship between cognitive dysfunction and depression. Moderation results suggest that the relationship between cognitive dysfunction and depression is dependent on coping style—adaptive coping protects individuals from experiencing depression related to their cognitive deficits; however, when individuals use maladaptive coping, cognitive dysfunction puts them at risk for depression. Mediational results suggest that cognitive dysfunction leads to depression partially due to cognitive dysfunction’s effects on coping. That is, cognitive deficits may impair individuals’ ability to use adaptive coping strategies, leaving them more likely to use maladaptive strategies. Clinical and theoretical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and memory bias interact to predict depression in multiple sclerosis.

This study is an investigation of the moderating effect of cognitive schema on the relationship between stress and depression in individuals with multiple sclerosis (MS). In the study, the authors employed a performance-based measure of affective memory bias and a self-report measure of everyday stress to assess both direct and interactive effects of cognitive schema and stress on depression in individuals with MS. The specific hypotheses were that high stress would be more highly associated with depression if an individual also demonstrated a bias for negative information, but that a bias for positive information may buffer against the effects of stress on depression. Results supported the hypotheses, demonstrating a significant effect of the interaction and differential effects of stress based on the direction of memory bias. Implications for understanding depression in MS are discussed, as well as dominant theories of adult depression in the general population. The results are also discussed as a potential contradiction to A. T. Beck's (1967, 1976) developmental hypothesis of cognitive schemas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent advances in the treatment of anxiety disorders.

[Correction Notice: An erratum for this article was reported in Vol 52(2) of Canadian Psychology/Psychologie canadienne (see record 2011-10782-004). The heading for the article was incorrectly printed. The corrected heading is provided in the erratum.] Over the past several decades, evidence-based treatments have emerged for each major anxiety disorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxiety disorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxiety disorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based strategies, enhancement of exposure using d-cycloserine, and the application of motivational interviewing strategies in anxiety disorders. For each of these treatments, the current status and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

Objective: This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Methods: Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Results: Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (β = .36, p     

Mediation of changes in anxiety and depression during treatment of social phobia.

To investigate the interactive process of changes in social anxiety and depression during treatment, the authors assessed weekly symptoms in 66 adult outpatients with social phobia (social anxiety disorder) who participated in cognitive- behavioral group therapy. Multilevel mediational analyses revealed that improvements in social anxiety mediated 91% of the improvements in depression over time. Conversely, decreases in depression only accounted for 6% of the decreases in social anxiety over time. Changes in social anxiety fully mediated changes in depression during the course of treatment. The theoretical and clinical implications of these findings for the relationship between anxiety and depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review.

Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’s g = 0.63) and mood symptoms (Hedges’s g = 0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’s g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning in families of children with anxiety disorders.

The authors examined maternal and paternal reports of family functioning and their relationship with child outcomes as well as the association between anxiety and depression in family members and family functioning. Results reveal that maternal and paternal reports of family functioning were both significantly associated with worse child outcomes, including child anxiety disorder (AD) severity, anxiety symptoms, and child global functioning. Maternal and paternal anxiety and depression predicted worse family functioning, whereas child report of anxiety and depression did not. Parents of children with ADs reported significantly worse family functioning and behavior control, but only fathers reported worse problem solving and affective involvement compared with fathers of children with no psychological disorders. Findings from this study suggest that paternal as well as maternal anxiety and depression play a role in worse family functioning in children with ADs and that unhealthier family functioning is associated with worse child outcomes in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders.

There is a substantial literature relating the personality trait anxiety sensitivity (AS; tendency to fear anxiety-related sensations) and its lower order dimensions to the mood and anxiety (i.e., internalizing) disorders. However, particularly given the disorders’ high comorbidity rates, it remains unclear whether AS is broadly related to these disorders or if it shows a pattern of differential relations. Meta-analyses of the concurrent relations of AS with the internalizing disorders were conducted based on 117 studies and 792 effect sizes. Mean Anxiety Sensitivity Index scores by diagnostic group and AS–symptom correlations both indicated that AS is most strongly related to panic, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). More specific analyses were also conducted on (a) AS correlations with symptom dimensions within individual disorders and (b) correlations between lower order AS components and symptoms. The meta-analytic correlation matrix for higher order AS–disorder relations was submitted to path analysis, modeling latent Distress disorders and Fear disorders that control for much of the shared variance among the disorders. Results of the path analysis indicated that AS is broadly related to these disorders but that agoraphobia, GAD, panic, and PTSD have the strongest associations. In addition, AS was more strongly related to the latent distress disorders than the fear disorders. Because of the contemporaneous assessment of AS and internalizing disorders in these studies, the results should not be taken to mean that AS has a stronger casual association with certain disorders. Implications for concurrent AS–internalizing relations, interpretations of the AS construct, and structural models of personality and psychopathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CRH? receptor antagonists for the treatment of depression and anxiety.

From basic and clinical studies, ample evidence has emerged that abnormalities of stress hormone regulation observed in depression and anxiety are caused by elevated secretion of hypothalamic corticotropin-releasing hormone (CRH). This neuropeptide acts through CRH? receptors to produce a number of anxiety- and depression-like symptoms, which has resulted in extensive validation of CRH? receptors as a potential drug target. A number of orally available nonpeptidergic small molecules that are able to pass the blood-brain barrier have been discovered. Some of these compounds have entered clinical development. The authors summarize results from clinical studies of 2 CRH? antagonists. One study designed as a safety and tolerability study also monitored amelioration of depression under 2 dose-escalation regimens. The compound studied, NBI-30775/R121919, was found to have a clinical profile comparable to that of paroxetine. In a second study the effect of another CRH? antagonist, NBI-34041, on stress hormone secretion in response to a psychosocial stressor was investigated. Administration of this compound to healthy controls was found to reduce the stress-elicited secretion of stress hormones. However, neither compound impaired the CRH-induced release of adrenocorticotropic hormone and cortisol, rejecting the possibility that the stress hormone system is impaired by CRH? antagonists. From these studies the authors conclude that both CRH? antagonists have psychotropic effects unrelated to their neuroendocrine action, in line with behavioral data obtained from transgenic mice with CRH? gene deletions. The psychotropic effects observed in the clinical studies underscore that CRH? antagonists constitute a novel treatment of depression and anxiety but may also serve to prevent negative sequelae of severe stressors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of affect-focused psychotherapy for antepartum depression.

Logically, psychotherapy should be the first-line treatment for depression during pregnancy, yet there have been very few nondrug interventions tested in this patient population. The present study examines the impact of affect-focused psychotherapy as a treatment for antepartum depression. The treatment model was thought to be feasible to test with this population because depressed pregnant women are in need of an integrative model that can engage the client quickly and work rapidly to reduce symptom distress. Participants were 10 pregnant women with major depressive disorder who were treated with five sessions of affect-focused psychotherapy, as outlined in a published treatment manual. All therapy sessions were videotaped. Results indicate that participants experienced significant improvements in depressive symptoms, as well as increased therapeutic alliance and patient-therapist bond. These preliminary results provide promising data that demonstrate the effectiveness of a short-term (five-session) affect-focused psychotherapeutic treatment with a patient population suffering from antepartum depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological treatment of late-life anxiety: An empirical review.

This study provides a meta-analytic review of nonpharmacological interventions for late-life anxiety, focusing on treatment efficacy. Included in the analysis are studies in which a comparison was made either to a control condition or to another treatment. A total of 15 outcome studies, published or reported between January 1975 and January 2002, were identified involving 495 participants (mean age exceeding 55.0 years and a grand mean of 69.5 years) and providing 20 separate treatment interventions. The analysis indicated that psychological interventions were reliably more effective than no treatment on self-rated and clinician-rated measures of anxiety, yielding an effect size of .55. Maintenance of treatment gains (a minimum of 6 months follow-up) was insufficiently reported across studies to allow for a reliable demonstration of an overall estimate of long-term efficacy. It is concluded that psychological interventions produce significant improvements, but the analyses must be qualified by data limitations in the research synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating anxiety and depression in older adults with generalized anxiety disorder.

To examine affect and cognition in differentiating anxiety and depression, 83 older participants with generalized anxiety disorder completed the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS). A 3-factor solution was found for the PANAS: positive affect (PA), anxiety and anger (Negative Affect 1 [NA-1]), and guilt and shame (Negative Affect 2 [NA-2]). A 2-factor structure was noted for the CCL. Correlations with anxiety and depression measures suggested that the CCL Depression (CCL-D) subscale showed stronger correlations with depression, whereas the CCL Anxiety subscale did not uniquely correlate with anxiety. The NA-1 subscale correlated positively with measures of depression and anxiety, whereas the PA subscale showed negative correlations. Hierarchical regression suggested that the CCL-D subscale was a significant predictor of self-reported depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV:Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)