Source Credit: ScienceDaily – Exposure/Ritual Prevention Therapy Boosts Antidepressant Treatment of OCD
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
Sep. 12, 2013 — NIMH grantees have demonstrated that a form of behavioral therapy can augment antidepressant treatment of obsessive compulsive disorder (OCD) better than an antipsychotic. The researchers recommend that this specific form of cognitive behavior therapy (CBT) — exposure and ritual prevention — be offered to OCD patients who don’t respond adequately to treatment with an antidepressant alone, which is often the case. Current guidelines favor augmentation with antipsychotics.
(EDIT- FROM JOURNAL ARTICLE- description of CBT intervention:
EX/RP Augmentation
Patients randomized to EX/RP received 17 twice-weekly 90- minute sessions delivered over 8 weeks by
a study therapist. Treatment included 2 introductory sessions, 15 exposure sessions (during which
patients faced their obsessional fears for a prolonged period without ritualizing), daily homework
(at least 1 hour of self-directed exposures daily), and between- session telephone check-ins.16 At least 2 sessions occurred outside the clinic to promote generalization to daily life. The goal was for patients to stop their rituals as early in treatment as possible; patients were asked to try refraining from ritualizing after the first exposure session. Formal cognitive therapy procedures were not used, but dysfunctional cognitions were discussed within the context of exposure.)
Click Image To Read Reviews. My Favourite Resource For OCD. New Edition Includes Mindfulness Strategies
In the controlled trial with 100 antidepressant-refractory OCD patients, 80 percent of those who received CBT responded, compared to 23 percent of those who received the antipsychotic risperidone, and 15 percent of those who received placebo pills. Forty-three percent experienced symptoms reduced to a minimal level following CBT treatment, compared to 13 percent for risperidone and 5 percent for placebo.
The study, published September 11, 2013 in JAMA Psychiatry, was led by Helen Blair Simpson, M.D., of Columbia University, in New York City; and Edna Foa, Ph.D., of the University of Pennsylvania, Philadelphia.
In an accompanying editorial, grantees Kerry Ressler, M.D., and Barbara Rothbaum, Ph.D., of Emory University, Atlanta, note that antidepressants are effective in treating only a subset of OCD patients. They add that the targeted form of CBT works via different mechanisms — such as retraining the brain’s habit-forming circuitry to unlearn compulsive rituals.
Matthew Rudorfer, M.D., chief of the NIMH Somatic Treatments Program, which funded the study, said that in demonstrating how different patients respond best to different approaches, it helps to move the field toward the goal of more personalized treatment.
READ THE COMPLETE ORIGINAL RESEARCH ARTICLE HERE
Journal Reference: Helen Blair Simpson. Cognitive-Behavioral Therapy vs Risperidonefor Augmenting Serotonin Reuptake Inhibitors in Obsessive-Compulsive DisorderA Randomized Clinical TrialSerotonin Reuptake Inhibitor Augmentation.JAMA Psychiatry, 2013; DOI: 10.1001/jamapsychiatry.2013.1932
September 14, 2013
Posted by peterhbrown |
anxiety, brain, Cognition, Cognitive Behavior Therapy, Obsessive Compulsive Disorder, research | Barbara Rothbaum, CBT, Cognitive behavioral therapy, compulsion, Emory University, Health, Medicine, Mental health, New York City, obsessive compulsive disorder, OCD, research, response prevention, risperdone, ritual, science, ssri, University of Pennsylvania |
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Source Credit:
“For some people social anxiety is pretty pervasive,” said Justin Weeks, Ph.D, an assistant professor of psychology and director of the Center for Evaluation and Treatment of Anxiety at Ohio University. For others, the anxiety arises in specific social situations, he said.
The most common example is anxiety over public speaking. Making small talk, eating in front of others and using public restrooms also can trigger worry and unease for some.
Some people engage in what Weeks called “covert avoidance.” For example, they might go to parties but instead of mingling, they hang back in the kitchen, he said.
Social anxiety is defined as anxiety anticipating a social situation or anxiety during or after that situation, Weeks said. “At the heart of social anxiety is the fear of evaluation.” And it’s not just negative evaluation that people worry about; it’s positive evaluation, too.
Weeks’s research suggests that people perceive negative consequences from a social situation whether they do poorly or well. (Here’s one study.) For instance, people who do well at work might worry about the social repercussions of outshining their coworkers, he said.
In other words, people with social anxiety simply don’t want to stand out. “They want to be as inconspicuous as possible.”
Anxiety about social situations lies on a spectrum. “The consensus among the experts is that shyness and social anxiety disorder are all part of one continuum,” Weeks said. “It’s a question of severity.”
How much does social anxiety interfere with your life?
For instance, you might wish that you were more comfortable when interacting with people, Weeks said. But “you don’t feel like it’s holding you back,” in terms of your personal or professional goals.
“Social anxiety is more severe.” A person might avoid going to college because schools require passing a public speaking course and interacting with new people. They might want a romantic relationship but worry so much about rejection that they avoid potential partners.
Below, Weeks shared his suggestions for overcoming social anxiety.
1. Try a self-help manual.
Self-help manuals are designed to supplement therapy, but they’re also good tools for working on your own, Weeks said. He suggested the Managing Social Anxiety workbook. (PETER’S NOTE: For Teens I highly recommend The Shyness and Social Anxiety Workbook for Teens: CBT and ACT Skills to Help You Build Social Confidence )
2. Work with a therapist.
If social anxiety is stopping you from doing things you want or need to do, or you haven’t had much success with self-help, seek professional help. Find a therapist who specializes in anxiety disorders. You can start your search here.
The Workbook Recommended by Dr Justin Weeks. Click Image To Read Reviews and View Content
3. Practice deep breathing every day.
It’s helpful to engage in deep breathing before an anxiety-provoking social situation, Weeks said. But practice this technique every day. This way it becomes second nature, and you don’t hyperfocus on deep breathing and miss an entire conversation, he said. Here’s more on deep breathing.
4. Create an exposure hierarchy.
An exposure hierarchy is a list – akin to a ladder – where you write down situations that cause you anxiety, in order of severity. Then you perform the easiest behavior, and keep moving up the list.
To create your own hierarchy, list 10 anxiety-provoking situations, and rate them on a 100-point scale (zero being no anxiety; 100 being severe anxiety). Your list might start with asking a stranger for directions and end with joining Toastmasters.
This website features a link to various worksheets on coping with social anxiety, and includes “the fear and avoidance hierarchy.” (Look for “managing social anxiety: workbook.”)
5. Create objective goals.
People tend to disqualify the positive when they feel anxious, Weeks said. They might do well, even great, but because of their anxious feelings, they see their performance as abysmal. That’s why therapists encourage clients to create objective behavioral goals, he said.
These are behaviors that anyone in the room would be able to observe. It doesn’t matter how you feel or whether you’re blushing or sweating (which you can’t control anyway) in a social situation.
For instance, if you’re working in a group setting, the objective behavior would be to make three comments, Weeks said.
This also gives you a good barometer for judging your progress. Again, you’re not focusing on whether you felt nervous. Rather, you’re focusing on whether you performed the actual behavior.
My Recommended Workbook for Teens. Click Image To Read Reviews and View Content
Also, avoid focusing on others’ reactions. It doesn’t matter how your colleagues received your idea in the meeting. What matters is that you actually spoke up. It doesn’t matter whether a girl or guy said yes to your dinner invite. What matters is that you actually asked. It doesn’t matter how your child’s teacher reacted when you declined to volunteer for yet another school trip. What matters is that you were assertive and respected your own needs.
As Weeks said, “You did what you wanted to in a situation. We can’t control what another person is going to do.”
6. Keep a rational outlook.
Dispute both bleak thoughts that undermine your performance and fuel your anxiety, and equally unrealistic thoughts that are irrationally positive, Weeks said.
For instance, if you’re giving a speech, you might initially think, “I’m going to bomb.” But if you’ve given speeches before and done well, then this isn’t a rational or realistic perspective. You might say instead, “I’ve given speeches before. I’m prepared, and I’ll give it my best shot.”
If you’re asking someone out, it’s not rational to think, “They’re definitely going to say yes.” But it is rational to consider, “They might,” according to Weeks.
If social anxiety is sabotaging your goals and stopping you from living the life you want, seek help and try the above strategies. Social anxiety is highly treatable, Weeks said. You can get better, and grow in the process.
September 11, 2013
Posted by peterhbrown |
Acceptance and Commitment Therapy, Adolescence, anxiety, Cognitive Behavior Therapy, Education, Health Psychology, research, therapy | anxiety, Cognitive behavioral therapy, Health, Mental health, Ohio University, Psych Central, self help, social anxiety, social phobia, workbook |
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A little while ago I posted a list of free interactive self-help web sites, all research based, which have been shown to effective in the treatment of anxiety & depression. A recent study adds to the body of evidence which supports web based intervention as a viable treatment option or adjunct.
Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.
Read the original research thesis here (PDF)
“Internet-based CBT is also more cost-effective than group therapy,” says Jan Bergström, psychologist and doctoral student at the Center for Psychiatry Research. “The results therefore support the introduction of Internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety.”
It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad ).
Click image to read reviews
It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.
The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.
Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.
“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.
Read the original research thesis here (PDF)
Credit: Adapted from materials provided by Karolinska Institutet.
April 18, 2010
Posted by peterhbrown |
anxiety, Books, Cognitive Behavior Therapy, depression, diagnosis, Education, Internet, research, stress, Technology, therapy | anxiety, CBT, Cognitive behavioral therapy, david burns, depression, Disorders, feeling good, Health, interactive, Internet, Major depressive disorder, Mental health, online, online help, Panic disorder, self help, Stockholm County Council, treatment, web, web site |
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Having an Honors degree in Human Movement Studies and working in gyms in a former life while studying for my Clinical Masters degree, I have seen this to be true. Of course it seems self evident, but these researchers have used great science with an excellent and now research-proven written program and workbook. These, along with their recent meta-analytic research review, show just how effective exercise can be in improving mood.
Credit: PhysOrg.com) — Exercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.
“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. “The more therapists who are trained in exercise therapy, the better off patients will be.”
The traditional treatments of cognitive behavioral therapy and pharmacotherapy don’t reach everyone who needs them, says Smits, an associate professor of psychology.
“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”
The Program used in the study is available from bookstores-Click Image to view description
Smits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.
Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).
The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.
“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”
After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.
At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.
The patient workbook which accompanies the program - Click image to view description
“Rather than emphasize the long-term health benefits of an exercise program — which can be difficult to sustain — we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy — and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”
Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.
“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”
April 5, 2010
Posted by peterhbrown |
anxiety, Books, brain, Cognitive Behavior Therapy, depression, Exercise, Health Psychology, Positive Psychology, research, Resilience, Resources, stress, therapy | Anxiety disorder, book, Boston University, Cognitive behavioral therapy, depression, energy, Exercise, happiness, Health, Mental health, mood, Oxford University Press, research, research based, self help, self-esteem, Southern Methodist University, stress, workbook |
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Peter H Brown Clinical Psychologist 