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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise therapy for patients with psychiatric disorders: Research and clinical implications.

There is now considerable evidence that regular exercise is (a) a viable, cost-effective, but underused treatment for mild to moderate depression that compares favorably to individual psychotherapy, group psychotherapy, and cognitive therapy, and (b) a necessary ingredient in effective behavioral treatments that reduce self-reported pain in individuals with chronic pain. Preliminary evidence also suggests that regular exercise deserves further attention as (a) a singular treatment for some anxiety disorders, for individuals suffering from body image disturbance, and for the reduction of problem behavior of developmentally disabled persons, and (b) an adjunct in treatment programs for schizophrenia, conversion disorder, and alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological dimensions of arthritis.

Reviews the literature on the psychological assessment and therapy of persons with arthritis, focusing primarily on the diagnostic category of rheumatoid arthritis. Assessment has involved attempts to define an arthritic personality using psychoanalytic concepts, but more recently it has included the identification of stressors as precursive and exacerbative of disease and the measurement of the impact of arthritis on psychosocial and functional variables. Psychological or behavioral therapy strategies for pain and stress management, psychotherapy in group settings, and attention to medical compliance are among the sparsely reported treatment techniques. It is concluded that therapies that initially address the physical condition, as opposed to mental health needs, are likely to be most acceptable to the patient and most successful in outcome. (72 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process.

Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of chronic pain and also examined 2 processes from this model, acceptance and values-based action. Participants included 171 completers of an interdisciplinary treatment program, 66.7% of whom completed a 3-month follow-up assessment as well. Results indicated significant improvements for pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance. Effect size statistics were uniformly medium or larger. According to reliable change analyses, 75.4% of patients demonstrated improvement in at least one key domain. Both acceptance of pain and values-based action improved, and increases in these processes were associated with improvements in the primary outcome domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety and depression during chemotherapy for lymphoproliferative diseases

In order to analyse anxiety and depression states observed during the treatment of lymphoproliferative diseases, a group of 23 patients were studied. For assessment of the variables the following was used: history taking, psychological observation and psychometric techniques. The obtained results point to various dynamics of anxiety and depression. The intensity of anxiety states decreases during single as well as successive courses of chemotherapy. Depression states intensify during one course with a tendency for mood lowering with prolonged treatment duration. Therapeutic conclusions: 1. It is necessary to minimize anxiety attitudes, particularly during the first phase of the treatment (cognitive psychotherapy). 2. In deep depression it is indicated to use antidepressants and supportive psychotherapy.     

Incorporating complementary and alternative medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain.

This article describes how psychological services for Veterans being seen in an interdisciplinary pain management program were expanded to include Complementary and Alternative Medicine (CAM) approaches. The benefits observed following the introduction of CAM therapies included: improved attendance and Veterans' involvement in group-based therapies, reductions in self-reported pain and anxiety, improved sleep, and an increased sense of emotional well being in the participants. The data also show that CAM therapies, when offered as a treatment option in the format of a drop-in group clinic, were associated with a modest but significant average pain reduction of 1.02 units on a 0–10 Numerical Rating scale. The CAM therapies described in this program are relatively inexpensive and portable, and can appear to the patient as conventional Western or “real” medical treatment (and perhaps, therefore, have less stigma than psychotherapy) for pain and associated distress. They also require minimal training to use and, therefore, can be used as a self-treatment at home. If proven to be effective in future controlled trials, their use could improve access to effective pain care, particularly for Veterans residing in the rural settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment styles and group psychotherapy attitudes.

The current study examined the relationship between 63 intake clients’ and 28 college student’s attachment styles and their attitudes of group psychotherapy. The authors examined the relationship between attachment anxiety and avoidance and the subscales of the Group Therapy Survey-R (Carter, Mitchell, & Krautheim, 2001). Results revealed a significant relationship between attachment avoidance in adult romantic relationships and increased fears of being vulnerable in group psychotherapy. As hypothesized, avoidance in romantic relationships was related to fears of shame and humiliation in group therapy. Contrary to predictions, clients’ anxiety ratings were negatively related to negative myths of group psychotherapy. The greater the clients rated fears of being rejected and abandoned, the less they rated negative myths about group treatment. Neither attachment anxiety nor avoidance was related to ratings of group therapy efficacy. Implications of the findings for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narcosynthesis in the treatment of posttraumatic chronic pain: A case study.

Presents the case history of a 49-yr-old White male with chronic traumatically induced pain complaints who was treated with narcosynthesis. Narcosynthesis was indicated because of the lack of initial success with behavioral treatment strategies, such as psychodrama-assisted implosion techniques and hypnosis-assisted desensitization. The use of sodium-amytal-assisted psychotherapy in the treatment of the condition proved singularly efficacious in the short term. In this therapy, the S was administered iv sodium amytal to induce narcosis and then regressed back by the therapist to the day of the industrial accident that had injured him. Repetition of emotionally laden material allowed the anxiety to subside. Upon awakening, all symptoms were absent. However, the symptoms began to worsen 3 mo later when the S found out that he would be returning to the same work. The role of narcosynthesis in the treatment of traumatically induced chronic pain is discussed, with special reference to a behavioral interpretation of the results obtained. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal psychotherapy for co-occurring depression and chronic pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover, when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans, and Latinos all report higher rates of pain and depression compared with other groups. This article describes a version of interpersonal psychotherapy tailored for patients with comorbid depression and chronic pain, interpersonal psychotherapy for depression and pain (IPT-P). IPT-P potentially could be delivered to many patient populations in a range of clinical settings, but this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non–treatment-seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option have the potential to improve clinical outcomes for individuals with depression and chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy in moderately severe COPD: a pilot study

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".     

Unique and common mechanisms of change across cognitive and dynamic psychotherapies.

The goal of this article was to examine theoretically important mechanisms of change in psychotherapy outcome across different types of treatment. Specifically, the role of gains in self-understanding, acquisition of compensatory skills, and improvements in views of the self were examined. A pooled study database collected at the University of Pennsylvania Center for Psychotherapy Research, which includes studies conducted from 1995 to 2002 evaluating the efficacy of cognitive and psychodynamic therapies for a variety of disorders, was used. Patient samples included major depressive disorder, generalized anxiety disorder, panic disorder, borderline personality disorder, and adolescent anxiety disorders. A common assessment battery of mechanism and outcome measures was given at treatment intake, termination, and 6-month follow-up for all 184 patients. Improvements in self-understanding, compensatory skills, and views of the self were all associated with symptom change across the diverse psychotherapies. Changes in self-understanding and compensatory skills across treatment were predictive of follow-up symptom course. Changes in self-understanding demonstrated specificity of change to dynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally sensitive psychotherapy for Puerto Rican children and adolescents: A program of treatment outcome research.

Recognition of cultural distance between Hispanic clients and non-Hispanic therapists has prompted efforts to introduce culture into therapy, but there is little evidence that such efforts influence treatment outcomes. This article evaluates treatment outcomes from a program of research on modeling therapy with Puerto Ricans, targeting anxiety symptoms, acting-out behavior, and self-concept problems. Evaluation of outcomes confirmed the impact of culturally sensitive modeling therapy on anxiety symptoms and other selected target behaviors, but negative treatment effects also were evident. Results suggest that new approaches to psychotherapy for special populations, such as Hispanic children and adolescents, should be buttressed by programmatic research oriented toward the comparative evaluation of treatment outcomes and should be attuned to therapeutic processes mediating between culture and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy with incarcerated offenders: A research synthesis.

The purpose of this study was to evaluate the efficacy of group psychotherapy with incarcerated offenders. Meta-analytic techniques were applied to 26 empirical studies that used a treatment group versus a control group. The outcome measures assessed in this study included institutional adjustment, anger, anxiety, depression, interpersonal relations, locus of control, and self-esteem. The results indicate that positive treatment effects were found for the use of group psychotherapy with incarcerated offenders across all outcomes. Supplemental analyses were also included to identify factors that contribute to the efficacy of group psychotherapy and indicate that the use of homework exercises resulted in significantly improved outcomes. Furthermore, participants mandated to treatment did not negatively influence the efficacy of group psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future roles for psychotherapy in the medical-surgical arena.

Discusses the role of psychotherapy in medical treatment, focusing on preventative health care. Risk for many medical conditions is tied to pathologic and habituated behavioral patterns that cannot be effectively addressed without psychological intervention. Factors such as depression and anxiety and corollary factors of eating and vigilance account for an impressive number of health risk components. Among the objectives targeted by the US Department of Health and Welfare for the next decade in which psychotherapy can play a major role are (1) reduction of sedentary behaviors and increase in physical activity; (2) reduction of obesity; (3) reduction of ongoing cigarette smoking and initiation of smoking; and (4) reduction of drug and alcohol use and alcohol-related motor vehicle deaths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between attachment scales and group therapy alliance growth differs by treatment type for women with binge-eating disorder.

The impact of the treatment context in influencing the relationship between attachment anxiety/avoidance and group therapy alliance growth was examined. Sixty-five women treatment completers with binge-eating disorder received 16 sessions of group cognitive behavioral therapy (GCBT) or group psychodynamic interpersonal psychotherapy (GPIP). Attachment scales were completed before treatment, and a group therapy alliance measure was completed after each therapy session. Growth curve modeling indicated an increasing linear growth in group therapy alliance for both treatments. For GPIP, higher attachment anxiety and lower attachment avoidance were each associated with alliance growth. These relationships were not evident for GCBT. The context of therapy likely activated (in the case of GPIP) or did not activate (in the case of GCBT) defensive attachment strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults.

Conducted a meta-analysis of 56 outcome studies of psychotherapy and drug therapy in the treatment of unipolar depression in adults. Five types of psychotherapy were examined: behavioral; social learning-interpersonal; cognitive; a combination of cognitive, social learning, and behavioral; and marital. 35 types of drug therapy were examined; the 2 most common were imipramine and amitriptyline. Findings suggest that psychotherapy (mean effect size 1.22) was superior to drug therapy (mean effect size .61) in treating unipolar depression. This finding is discussed in relation to the relative strengths and weaknesses of narrative vs qualitative approaches to synthesizing the findings of many studies. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts.

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up

STUDY DESIGN: A multicenter, randomized, single-blinded controlled trial with 1-year follow-up. OBJECTIVES: To evaluate the efficiency of progressively graded medical exercise therapy, conventional physiotherapy, and self-exercise by walking in patients with chronic low back pain. SUMMARY AND BACKGROUND DATA: Varieties of medical exercise therapy and conventional physiotherapy are considered to reduce symptoms, improve function, and decrease sickness absence, but this opinion is controversial. METHODS: Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 52 weeks (Sickness Certificate II) were included. The treatment lasted 3 months (36 treatments). Pain intensity, functional ability, patient satisfaction, return to work, number of days on sick leave, and costs were recorded. RESULTS: Of the 208 patients included in this study, 71 were randomly assigned to medical exercise therapy, 67 to conventional physiotherapy, and 70 to self-exercise. Thirty-three (15.8%) patients dropped out during the treatment period. No difference was observed between the medical exercise therapy and conventional physiotherapy groups, but both were significantly better than self-exercise group. Patient satisfaction was highest for medical exercise therapy. Return to work rates were equal for all 3 intervention groups at assessment 15 months after therapy was started, with 123 patients were back to work. In terms of costs for days on sick leave, the medical exercise therapy group saved 906,732 Norwegian Kroner (NOK) ($122,531.00), and the conventional physiotherapy group saved NOK 1,882,560 ($254,200.00), compared with the self-exercise group. CONCLUSIONS: The efficiency of medical exercise therapy and conventional physiotherapy is shown. Leaving patients with chronic low back pain untampered poses a risk of worsening the disability, resulting in longer periods of sick leave.     

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)