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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Panic! Its Prevalence, Diagnosis and Treatment via the Internet

Carlbring, Per January 2004 (has links)
As evidenced by several trials, cognitive behavior therapy (CBT) is a highly effective treatment for Panic disorder with or without agoraphobia (PD). However, therapists are short in supply, and patients with agoraphobia may not seek therapy due to fear of leaving their homes or traveling certain distances. A major challenge therefore is to increase the accessibility and affordability of evidence-based psychological treatments. This thesis is based on five studies; three treatment studies set up as randomized controlled trails (RCT), one prevalence study, and one study testing the equivalence of an Internet-administered diagnostic assessment tool with a clinician-administered interview. Study I showed that the Swedish 12-month PD prevalence is consistent with findings in most other parts of the Western world (2.2%; CI 95% 1.0%-3.4%). There was a significant sex difference, with a greater prevalence for women (3.6%) compared to men (0.7%). Study II showed that the validity of the computerized diagnostic interview (CIDI-SF) was generally low. However, the agoraphobia and obsessive-compulsive disorder modules had good specificity and sensitivity, respectively. The three RCTs showed, directly or indirectly, that Internet-based self-help is superior to a waiting-list. When 10 individual weekly sessions of CBT for PD was compared with a 10-module self-help program on the Internet, the results suggest that Internet-administered self-help, plus minimal therapist contact via e-mail, is as effective as traditional individual CBT (80% vs. 67% no longer met criteria for panic disorder; composite within-group effect size was Cohen’s d= 0.78 vs. 0.99). One-year follow-up confirmed the results (92% vs. 88% no longer met criteria for panic disorder; d= 0.80 vs. 0.93). The results generally provide evidence to support the continued use and development of Internet-distributed self-help programs.
32

Behavioral Treatments of Panic Disorder with Agoraphobia : Treatment Process and Determinants of Change

Ramnerö, Jonas January 2005 (has links)
The present dissertation comprises four empirical studies within the area of behavioral treatment of panic disorder with agoraphobia. The focus is on studying issues pertaining to outcome, treatment process and determinants of change. The first study is a randomized controlled treatment study of 73 patients undergoing 16 sessions of either exposure in vivo (E), or cognitive behavior therapy (CBT). Both treatments showed clear improvements at post-treatment that were well maintained at 1-year follow up, and there were no significant differences between the treatments. The second study concerned prediction of outcome in the same sample. From a variety of pre-treatment characteristics severity of avoidance was the one most related to outcome. Most predictors were found unrelated. Two approaches of prediction were also compared: treating outcome as a categorical vs. continuous variable. The different approaches yielded a somewhat dissimilar picture of the impact of pre-treatment severity of avoidance. The third study examined different aspects of the therapeutic relationship, and their relation to outcome. Clients’ perceptions of therapists and their ratings of the working alliance were generally not related to outcome at any point. On the other hand, therapists’ perceptions of patients as showing goal-direction and active participation were related to outcome from early on in therapy. The fourth study examined different aspects of change. It was found that change in indices of the frequency of panic attacks was not closely related to change in agoraphobic avoidance at post-treatment. Change in avoidance was also more related to other aspects of outcome. At one-year follow-up, a more unitary picture, regarding the different aspects of change was observed.
33

Agoraphobia and Panic

Wittchen, Hans-Ulrich, Nocon, Agnes, Beesdo, Katja, Pine, Daniel S., Höfler, Michael, Lieb, Roselind, Gloster, Andrew T. 29 November 2012 (has links) (PDF)
Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline. Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.
34

Dynamics of Defensive Reactivity in Patients with Panic Disorder and Agoraphobia: Implications for the Etiology of Panic Disorder

Richter, Jan, Hamm, Alfons O., Pané-Farré, Christiane A., Gerlach, Alexander L., Gloster, Andrew T., Wittchen, Hans-Ulrich, Lang, Thomas, Alpers, Georg W., Helbig-Lang, Sylvia, Deckert, Jürgen, Fydrich, Thomas, Fehm, Lydia, Ströhle, Andreas, Kircher, Tilo, Arolt, Volker 15 August 2013 (has links) (PDF)
Background: The learning perspective of panic disorder distinguishes between acute panic and anxious apprehension as distinct emotional states. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues. The current study tested this model by investigating the dynamics of defensive reactivity in a large group of patients with panic disorder and agoraphobia (PD/AG). Methods: Three hundred forty-five PD/AG patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defense reactivity was assessed measuring avoidance and escape behavior, self-reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during exposure of the behavioral avoidance test. Results: Panic disorder and agoraphobia patients differed substantially in their defensive reactivity. While 31.6% of the patients showed strong anxious apprehension during this task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 20.9% of the patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses resembled the pattern observed during the 34 reported panic attacks. Conclusions: We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. These data support the learning perspective of panic disorder.
35

Effekte therapeutenbegleiteter versus patientengeleiteter Exposition bei Panikstörung mit Agoraphobie

Lang, Thomas, Helbig-Lang, Sylvia, Gloster, Andrew T., Richter, Jan, Hamm, Alfons O., Fehm, Lydia, Fydrich, Thomas, Gerlach, Alexander L., Ströhle, Andreas, Alpers, Georg W., Gauggel, Siegried, Kircher, Tilo, Deckert, Jürgen, Höfler, Michael, Arolt, Volker, Wittchen, Hans-Ulrich 09 July 2013 (has links) (PDF)
Theoretischer Hintergrund: Die Rolle der Therapeutenbegleitung während Expositionsübungen bei Panikstörung mit Agoraphobie (P/A) ist bislang ungeklärt. Eine kürzlich durchgeführte klinische Studie (MAC-Studie) lieferte Hinweise auf ein günstigeres Behandlungsergebnis bei Therapeutenbegleitung. Fragestellung: Wie lassen sich Effekte therapeutenbegleiteter Exposition (T+) im Vergleich zu Exposition ohne Therapeutenbegleitung (T–) erklären? Methode: Daten von 301 Patienten, die eine expositionsbasierte KVT mit bzw. ohne Therapeutenbegleitung erhalten hatten, wurden analysiert. Untersucht wurden der Einfluss der initialen Störungsschwere, des Sicherheitsverhaltens sowie differenzielle Effekte der Bedingungen auf die Angst vor der Angst. Zusätzlich wurde überprüft, inwieweit die Übungshäufigkeit in den Behandlungsbedingungen variiert und einen Mediator des Behandlungserfolgs darstellt. Ergebnisse: Störungsschwere und Sicherheitsverhalten zeigten keine differenziellen Effekte zwischen den Bedingungen; die T+ Bedingung führte jedoch zu stärkeren Reduktionen der Angst vor der Angst im Angstsensitivitätsindex. Patienten der T+ Bedingung führten häufiger selbständig Expositionsübungen durch, während Patienten in T– im Durchschnitt länger übten. Die Übungshäufigkeit stellte dabei einen Mediator des Behandlungserfolgs dar. Schlussfolgerungen: Günstigere Effekte einer therapeutenbegleiteten Exposition gehen auf stärkere Reduktionen der Angst vor der Angst sowie auf eine höhere Übungshäufigkeit im Selbstmanagement zurück. / Theoretical background: There is a paucity of studies examining the role of therapist guidance during in-vivo exposure for panic disorder with agoraphobia (PD/AG). A recent study (MAC-study) suggested superior effects of therapist-guided exposure compared to programmed practice. Objectives: Examining potential mechanisms of therapist-guided exposure. Methods: Data from 301 patients with PD/AG who received either CBT with therapist guidance during in-vivo exposure (T+), or CBT with programmed exposure practice (T–) were analysed in regard to effects of initial symptom severity, subtle avoidance behaviours, reductions in fear of fear, and frequency of exposure homework. Results: There were no interaction effects between symptom severity or subtle avoidance and outcome. T+ was associated with higher reductions in fear of fear as well as with higher frequency of exposure homework. Frequency of exposure homework mediated the effect of group on outcome. Conclusion: Advantages of therapist-guided exposure as well as frequency of self-exposure might be attributed to higher reductions in fear of fear.
36

Agoraphobia and Panic: Prospective-Longitudinal Relations Suggest a Rethinking of Diagnostic Concepts

Wittchen, Hans-Ulrich, Nocon, Agnes, Beesdo, Katja, Pine, Daniel S., Höfler, Michael, Lieb, Roselind, Gloster, Andrew T. January 2008 (has links)
Background: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. Methods: DSM-IV syndromes were assessed via Composite International Diagnostic Interview – Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14–24 years at baseline. Results: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0–23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. Conclusions: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.
37

The epidemiology of panic disorder and agoraphobia in Europe

Goodwin, Renee D., Faravelli, Carlo, Rosi, S., Cosci, F., Truglia, E., Graaf, Ron de, Wittchen, Hans-Ulrich January 2005 (has links)
A literature search, in addition to expert survey, was performed to estimate the size and burden of panic disorder in the European Union (EU). Epidemiologic data from EU countries were critically reviewed to determine the consistency of prevalence estimates across studies and to identify the most pressing questions for future research. A comprehensive literature search focusing on epidemiological studies in community and clinical settings in European countries since 1980 was conducted (Medline, Web of Science, Psychinfo). Only studies using established diagnostic instruments on the basis of DSM-III-R or DSM-IV, or ICD-10 were considered. Thirteen studies from a total of 14 countries were identified. Epidemiological findings are relatively consistent across the EU. The 12-month prevalence of panic disorder and agoraphobia without history of panic were estimated to be 1.8% (0.7–2.2) and 1.3% (0.7–2.0) respectively across studies. Rates are twice as high in females and age of first onset for both disorders is in adolescence or early adulthood. In addition to comorbidity with agoraphobia, panic disorder is strongly associated with other anxiety disorders, and a wide range of somatoform, affective and substance use disorders. Even subclinical forms of panic disorder (i.e., panic attacks) are associated with substantial distress, psychiatric comorbidity and functional impairment. In general health primary care settings, there appears to be substantial underdiagnosis and undertreatment of panic disorder. Moreover, panic disorder and agoraphobia are poorly recognized and rarely treated in mental health settings, despite high health care utilization rates and substantial long-term disability.
38

Arquitetura e luto na obra de Adolf Loos / Architecture and mourning in the work of Adolf Loos

Joelsons, Denis 05 June 2017 (has links)
O presente trabalho propõe a leitura da obra de Adolf Loos (1870-1933) através das transformações históricas que marcaram a Europa na passagem da segunda metade do século XIX à primeira do século XX. A complexidade de sua obra é uma expressão privilegiada para o entendimento das contradições instauradas no período. Por um lado, o fôlego de suas ideias é dado pela persistência de problemáticas que surgiram no século XIX; por outro, parte de sua obsolescência também se explica pela resistência que Loos apresentou a tais mudanças. Transformações que ele identificou como perdas. O tema da perda permeia toda sua produção: nos edifícios, por vezes ele figura na justaposição de elementos contraditórios (tradição ou modernidade), por outras na cisão irreparável entre interior e exterior (público ou privado) e, em alguns casos, o uso de espelhos e aberturas simetricamente dispostas cria uma tensão de ambiguidade entre espaço e imagem (realidade e representação). O eixo de leitura proposto nesta dissertação se estabelece a partir das reações do arquiteto às perdas impostas por sua época. A obra estudada é interpretada como um trabalho de luto. Textos e edifícios representativos do pensamento de Adolf Loos são investigados à luz de algumas reflexões de importantes pensadores da cultura europeia do período, como Walter Benjamin, Camilo Sitte, Georg Simmel e Sigmund Freud. A abordagem se dá através de três temas centrais: a morte da tradição, a perda de vitalidade no espaço público das metrópoles e a decadência da experiência subjetiva. / It has been over a century since Adolf Loos\'s (1870-1933) most famous works, such as Ornament and Crime (1908) and Goldman & Salatsch building (1911), came to fruition. And, in spite of that, the contradictory nature of his legacy as an architect and writer still fuels and replenishes the debates and investigations of scholars to this day. This dissertation proposes a look at Adolf Loos\'s works through the historical transformations that characterized the transition of the second half of the nineteenth century to the twentieth century. The complexity of his production is a powerful expression of the contradictions that established this period. On one hand, the perseverance of his ideas comes from the persistence of issues that were originated on the nineteenth century, on the other; his obsolescence can also be explained by his opposition to the changes that came along with the new century. Loos identifies these changes as losses. Loss is a theme that impregnates all his production. In his architecture it often surfaces as contradictory elements (tradition and modernity) overlapping one another, or, at times, as an irreparable rupture between interior and exterior (public and private), and in some cases he creates a tension of ambiguity between space and image (reality and representation) by the use of mirrors and symmetrically opposed openings. It is this demeanor, and his reactions to the losses imposed by his time, that will be the axis that guides this dissertation. We can interpret many signs in his work as symbols of mourning. We investigate writings and buildings that represent his thought through the light of important contemporary thinkers of occidental culture, such as Walter Benjamin, Georg Simmel, Camilo Sitte e Sigmund Freud. We will approach his production by three lines: the death of tradition, the loss of vitality of public spaces in the metropolis and the decadence of subjective experience.
39

Mechanism of action in CBT (MAC): methods of a multi-center randomized controlled trial in 369 patients with panic disorder and agoraphobia

Gloster, Andrew T., Wittchen, Hans-Ulrich, Einsle, Franziska, Höfler, Michael, Lang, Thomas, Helbig-Lang, Sylvia, Fydrich, Thomas, Fehm, Lydia, Hamm, Alfons O., Richter, Jan, Alpers, Georg W., Gerlach, Alexander L., Ströhle, Andreas, Kircher, Tilo, Deckert, Jürgen, Zwanzger, Peter, Arolt, Volker 22 February 2013 (has links) (PDF)
Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.
40

(Don't) panic in the scanner! How panic patients with agoraphobia experience a functional magnetic resonance imaging session

Lüken, Ulrike, Mühlhan, Markus, Wittchen, Hans-Ulrich, Kellermann, Thilo, Reinhardt, Isabelle, Konrad, Carsten, Lang, Thomas, Wittmann, André, Ströhle, Andreas, Gerlach, Alexander L., Ewert, Adrianna, Kircher, Tilo 13 August 2013 (has links) (PDF)
Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n = 89 patients and n = 90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research.

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