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A brief cognitive behavioural preimplantation and rehabilitation programme for patients receiving an implantable cardioverter-defibrillator improves physical health and reduces psychological morbidity and unplanned readmissions.

Heart. 2009 Jan;95(1):63-9

Authors: Lewin RJ, Coulton S, Frizelle DJ, Kaye G, Cox H

OBJECTIVE: To assess the clinical and cost effectiveness of a brief home-based cognitive behavioural rehabilitation programme (the ICD Plan) for patients undergoing implantation of a cardiac defibrillator. DESIGN: A prospective multicentred, intention-to-treat, cluster-randomised controlled trial. SETTING: Eight implantable cardioverter-defibrillator (ICD) implantation centres in the UK. PATIENTS: Consecutive series of patients undergoing implantation with an ICD. INTERVENTIONS: The control group received usual care and advice from an experienced healthcare professional. The intervention group received usual care plus the ICD Plan. The plan was introduced before implantation, with three further brief telephone contacts with the nurse over the next 12 weeks. MAIN OUTCOME MEASURES: Health-related quality of life (Short Form Health Survey (SF-12)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), activity limitations (subscale from the Seattle Angina Questionnaire (SAQ)), unplanned admissions and other economic data using a questionnaire developed for the study. RESULTS: 192 patients were recruited to the study (71 intervention, 121 control). At 6 months after surgery the intervention group had better physical health (37.83 vs 34.24; p<0.01), fewer limitations in physical activity (34.02 vs 31.72; p = 0.04), a greater reduction in the proportion of patients with a borderline diagnosis of anxiety (21% vs 13%; p = 0.60) and depression (13% vs 2%; p = 0.30), more planned ECGs (89% vs 66%; p = 0.04) and 50% fewer unplanned admissions (11% vs 22%; p<0.01). CONCLUSIONS: The ICD Plan improved health-related quality of life, reduced the incidence of clinically significant psychological distress and significantly reduced unplanned readmissions. It is a cost effective and easily implemented method for delivering rehabilitation and psychological care to patients undergoing ICD implantation. Trial registration number: ISRCTN70212111.

PMID: 18070951 [PubMed - indexed for MEDLINE]

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Catastrophic associations predict level of change in anxiety sensitivity in response to cognitive-behavioural treatment for panic.

Behav Res Ther. 2008 May;46(5):557-72

Authors: Schneider R, Schulte D

The aim of the present study was to elucidate one of the factors that might be responsible for the maintenance of panic patients’ harmful beliefs about anxiety. Specifically, it was hypothesized that harmful beliefs about anxiety, i.e. anxiety sensitivity, is maintained in panic patients by automatic activation of idiographic catastrophic cognitions. To test this prediction, panic patients participated in a one-session cognitive-behavioural treatment of 4-8h to reduce anxiety sensitivity. The strength of automatic catastrophic cognitions in response to idiographic anxiety symptoms, measured with a modified semantic priming task, as well as the strength of the consciously accessible catastrophic meaning of these symptoms were assessed before treatment. In accordance with the hypothesis, stronger automatic catastrophic cognitions predicted a smaller reduction of anxiety sensitivity independently of the strength of conscious catastrophic cognitions. Moreover, in a first exploration, the strength of catastrophic associations was also shown to have an incremental predictive value for change in anxiety sensitivity beyond that of a number of demographic, clinical, treatment and assessment variables. The theoretical and clinical implications are discussed.

PMID: 18342292 [PubMed - indexed for MEDLINE]

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Daytime functioning in older patients suffering from chronic insomnia: treatment outcome in a randomized controlled trial comparing CBT with Zopiclone.

Behav Res Ther. 2008 May;46(5):623-41

Authors: Omvik S, Sivertsen B, Pallesen S, Bjorvatn B, Havik OE, Nordhus IH

The paper presents data from a randomized controlled trial comparing treatment effects of cognitive behavioural therapy (CBT), hypnotic treatment (Zopiclone), and placebo in a sample of insomnia patients. Data from the same trial have already demonstrated that CBT was more efficient in improving sleep than Zopiclone. The novel outcomes that are reported here concern daytime functioning. Forty-six older patients (age >or= 55) qualifying for a diagnosis of primary insomnia were recruited to participate. Assessments were completed at baseline, post-treatment, and at a 6-months follow-up, and measures of worry, anxiety, depression, interpersonal relationships, subjective alertness, vigilance, and quality of life were used. The participants in both treatment conditions scored within the normal range on the outcome measures at baseline with the exception of reporting less alertness, relative to a group of good sleepers. One interaction effect indicated that subjective alertness improved more in the Zopiclone group than the CBT group from baseline to post-treatment, and another that CBT was more effective than Zopiclone in reducing trait anxiety from baseline to follow-up. It was concluded that the treatments yielded only minor effects on the measures of daytime functioning, and that none of them was clearly superior to the other.

PMID: 18417099 [PubMed - indexed for MEDLINE]

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Accuracy of retrospective memory and covariation estimation in patients with obsessive-compulsive disorder.

Behav Res Ther. 2008 May;46(5):642-55

Authors: Gloster AT, Richard DC, Himle J, Koch E, Anson H, Lokers L, Thornton J

Assessment methods relying on biased or inaccurate retrospective recall may distort knowledge about the nature of disorders and lead to faulty clinical inferences. Despite concerns about the accuracy of retrospective recall in general and in particular with obsessive-compulsive disorder (OCD) patients, the accuracy of retrospective recall for one’s own symptoms assessed in vivo is unknown in this population. This study used a prospective ecological momentary assessment (EMA) methodology to create a criterion against which to assess recall accuracy in OCD patients. Although results indicated that patients’ retrospective recall of OCD symptoms was fairly accurate, they consistently overestimated the magnitude of OCD symptom covariation with non-OCD facets (e.g., sleep duration, contemporaneous stress level, etc.). Findings suggest that even when recall of OCD symptoms is accurate, patients may be inaccurate in estimating symptom covariation. The findings have implications for the research, case conceptualization, and assessment of OCD, and may extend to other disorders.

PMID: 18417100 [PubMed - indexed for MEDLINE]

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Anxiety sensitivity: a unique predictor of dropout among inner-city heroin and crack/cocaine users in residential substance use treatment.

Behav Res Ther. 2008 Jul;46(7):811-8

Authors: Lejuez CW, Zvolensky MJ, Daughters SB, Bornovalova MA, Paulson A, Tull MT, Ettinger K, Otto MW

The present study examined the extent to which anxiety sensitivity (AS) at treatment entry was related to prospective treatment dropout among 182 crack/cocaine and/or heroin-dependent patients in a substance use residential treatment facility in Northeast Washington, DC. Results indicated that AS incrementally and prospectively predicted treatment dropout after controlling for the variance accounted for by demographics and other drug use variables, legal obligation to treatment (i.e., court-ordered vs. self-referred), alcohol use frequency, and depressive symptoms. Findings are discussed in relation to the role of AS in treatment dropout and substance use problems more generally.

PMID: 18466878 [PubMed - indexed for MEDLINE]

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An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering.

J Speech Lang Hear Res. 2008 Dec;51(6):1451-64

Authors: Menzies RG, O’Brian S, Onslow M, Packman A, St Clare T, Block S

PURPOSE: The aims of the present study were to (a) examine the rate of social phobia among adults who stutter, (b) study the effects of speech restructuring treatment on social anxiety, and (c) study the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety. METHOD: Thirty-two adults with chronic stuttering were randomly allocated to receive either speech restructuring following a CBT package for social anxiety or speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post-CBT, post-speech restructuring, and 12 months follow-up. RESULTS: Sixty percent of our cohort were diagnosed with social phobia. Speech restructuring treatment alone had no impact on the social phobia of our cohort at 12 months follow-up. At follow-up, participants who had received CBT showed no social phobia and greater improvements than control participants on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with social phobia. CONCLUSION: The CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency.

PMID: 18664696 [PubMed - indexed for MEDLINE]

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Use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy.

Child Maltreat. 2008 Nov;13(4):377-82

Authors: Funderburk BW, Ware LM, Altshuler E, Chaffin M

This brief report discusses the use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy (PCIT). PCIT is an empirically supported behavioral parent training program for reducing disruptive behavior in young children and for reducing future rates of child physical abuse. The positive impact PCIT has demonstrated in reducing child maltreatment has galvanized interest in widespread dissemination of the PCIT model into child service systems. PCIT has traditionally been taught in university-based training programs in a mentored cotherapy model. By contrast, in field settings, PCIT training typically consists of workshop training supplemented by a period of telephone consultation (PC). Given concerns with the level of practitioner competency and fidelity yielded by the PC model, PCIT training programs have begun to examine Internet-based telemedicine technology to deliver live, mentored PCIT training to trainees at remote locations (Remote Real-Time or RRT) to better approximate the university-based training model. Challenges of disseminating evidence-based practices are discussed, using PCIT as a model of how these challenges are being addressed by telemedicine technology.

PMID: 18843144 [PubMed - indexed for MEDLINE]

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World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.

World J Biol Psychiatry. 2008;9(4):248-312

Authors: Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, , Zohar J, Hollander E, Kasper S, Möller HJ, Bandelow B, Allgulander C, Ayuso-Gutierrez J, Baldwin DS, Buenvicius R, Cassano G, Fineberg N, Gabriels L, Hindmarch I, Kaiya H, Klein DF, Lader M, Lecrubier Y, Lépine JP, Liebowitz MR, Lopez-Ibor JJ, Marazziti D, Miguel EC, Oh KS, Preter M, Rupprecht R, Sato M, Starcevic V, Stein DJ, van Ameringen M, Vega J

In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

PMID: 18949648 [PubMed - indexed for MEDLINE]

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Introduction: focusing on the psychoanalyst’s intentions in theory of technique.

Psychoanal Rev. 2008 Oct;95(5):701-9

Authors: Barnett AJ

PMID: 18999946 [PubMed - indexed for MEDLINE]

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The (and this) analyst’s intentions.

Psychoanal Rev. 2008 Oct;95(5):711-27

Authors: Lichtenberg J

PMID: 18999947 [PubMed - indexed for MEDLINE]

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