Purpose: There is growing interest in the clinical application of mindfulness meditation. However, little is known about the extent to which clients prefer mindfulness-based interventions (MBI) over conventional psychological therapies. The present study examined predictors of treatment preference and credibility in individuals with social anxiety disorder (SAD) who participated in a randomized trial of a mindfulness intervention adapted for SAD (MBI-SAD) versus a conventional psychological therapy (cognitive behavior group therapy; CBGT). Method: The sample included 97 adults who met DSM-5 criteria for SAD. Binary logistic and multiple linear regressions were conducted to examine baseline sociodemographic and clinical predictors of treatment preference for the MBI-SAD and perception of treatment credibility. Analysis of variance was used to compare levels of trait mindfulness across treatment preference groups. Results: The majority of participants (49%) reported a preference for the MBI-SAD. Ratings of treatment credibility were comparable for the two interventions. Employment status significantly predicted preference for CBGT versus the MBI-SAD, whereas younger age predicted preference for CBGT. Higher household income, a history of psychotherapy, elevated scores on clinician ratings of depression and social anxiety, and lower scores on self-report depression predicted no treatment preference. Higher household income predicted greater perceived credibility of treatment. Trait mindfulness did not differ across the treatment preference groups or predict treatment credibility. Discussion: Mindfulness meditation appears to be an acceptable and credible treatment for SAD. However, few baseline demographic and clinical characteristics predicted preference for the MBI-SAD. Additional research is needed to explore factors that shape preference and beliefs about mind-body interventions.

Generalized Anxiety Disorder (GAD) is a chronic, disabling, and prevalent disorder that is characterized by excessive worry, high anxiety symptoms, and tension. While the understanding of GAD has developed greatly in the past decade, much of the underlying mechanisms and pathology are still unknown. Due to a poor understanding of GAD and a high rate of comorbidity with other disorders, GAD is often misdiagnosed and mistreated. GAD is treated with psychotherapy, typically cognitive behavioral therapy (CBT), and pharmacotherapy, typically benzodiazepines and antidepressants. However, the treatment response is often inefficient, greatly varied and not well understood in many patients. As patients suffering from GAD are frequent hospital and primary care users, GAD causes a substantial economic burden on both the patient and society. In order to alleviate the burden caused by GAD, much research is being performed to more efficiently diagnose and treat the disorder. Potentially the amendment of the Diagnostic and Statistical Manual of Mental Disorders, with the fifth addition (DSM-V), might improve the diagnostic criteria and outcome of GAD. As mechanisms behind the pathology of GAD are discovered such as the contrast avoidance model, a better method for treating GAD may be applied. The goal of this review is to discuss the large burden caused by GAD and how it may be resolved in the future.

The present study investigated the efficacy of heart rate feedback training in the treatment of panic disorder. Eight patients with anxiety disorders participated in 7 feedback sessions, in which they were instrumentally trained to produce increases and decreases in heart rate in the presence of visual feedback. When they could successfully differentiate between the increase and decrease responses, subjects were instructed to use the decrease response to control anxiety and panic, and to avoid the increase response. Subjects were not made aware of the target responses until training was completed. Clinical improvement was measured through the administration of a psychometric test battery and a daily anxiety/panic diary. A non-anxious Control group, consisting of 10 subjects, was utilized to provide comparisons with the Anxiety group in the areas of feedback skill, baseline psychophysiology, and change in anxiety levels with the development of feedback skill. As a result of feedback training, Anxiety patients learned to produce increases and decreases in heart rate in the presence and absence of feedback. They also reported a decline in anxiety and panic over the course of feedback training. To evaluate whether clinical improvement was related specifically to feedback skill as opposed to non-specific treatment factors, dose-response relations were examined, where a dose was defined as a subject's degree of differentiation between increases and decreases in heart rate, as measured by a t-test. Clinical improvement was measured as the change in number of panic attacks per day, compared to baseline. A positive, significant correlation was found between subjects' degree of feedback skill and decline in panic at a one-month follow-up. A number of alternative explanations for the dose-response relationship are discussed, as well as the limitations of this study. It is concluded that further well-controlled studies will be required to confirm these findings, and to determine the source of the dose-response relationship, although this study provides encouraging evidence for the use of feedback training as a behavioral treatment for panic disorder. / Thesis / Master of Science (MS)

Objective: This study examined (a) the distribution of physical symptoms in youth with specific primary anxiety disorders (i.e. separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and social phobia [SP]) and (b) their response to treatment with cognitive-behavioral therapy (CBT; 14 sessions of CBT over the course of 12 weeks), medication, combination therapy (CBT + medication), or pill placebo in a sample. Method: Anxiety disordered youth (N = 488, age 7-17) who met criteria for a primary diagnosis of GAD, SAD, and/or SP as part of the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al. 2008) were included in this study. The sample was diverse and included children with comorbid secondary diagnoses. Results: The most common somatic complaints were headache, stomach pain or aches, feeling drowsy or too sleepy, head cold or sniffles, and sleeplessness. The distribution of these complaints did not differ across diagnostic groups. The number and severity of physical symptoms decreased over the course of treatment. Treatment condition, including placebo, was unrelated to the number and severity of physical symptoms posttreatment. Conclusions: Treatment of anxiety leads to a decrease in the number and severity of physical symptoms experienced in anxiety-disordered youth, irrespective of treatment type. / Psychology

Despite the ostensible prevalence of academic worry at the college and university level, there is a paucity of research in this area. In addition, there is an even greater dearth of research investigating treatments for excessive and uncontrollable academic worry. Further, the research on non-pharmacological treatment strategies for reducing pathological worry (as seen in its most severe form in generalized anxiety disorder; GAD) is limited. The primary goal of this study was to investigate the potential benefits of two self-administered interventions for reducing pathological academic worry. Participants experiencing pathological academic worry (N = 113) were randomized to one of four conditions: (a) worry exposure (WE), (b) expressive writing (EW), (c) a credible placebo control, consisting of pulsed audio-photic stimulation (APS), and (d) wait-list control (WLC). Participants were instructed to practice their interventions three times per week for one month. Participants in all three of the intervention conditions showed significant improvement on self-report measures, while no such changes were observed for the control group. Findings were mixed on the objective measures. In general, neither the WE nor EW conditions consistently outperformed placebo, and in some cases, EW failed to outperform the waitlist control group at post-treatment. Overall, those assigned to WE showed greater improvement than those assigned to EW at posttreatment, but few significant differences between the three intervention groups emerged at follow-up. These mixed findings suggest that either the efficacy of each of the treatments does not go beyond the that which would be expected of non-specific treatment effects, or that the pulsed audio-photic stimulation did in fact exert more of an effect than a typical placebo, suggesting there may have been an unanticipated active treatment component. Despite this, several participants in WE and EW showed marked improvement, and even continued improvement by follow-up, suggesting that, while perhaps not highly potent treatments when delivered in isolation, these may be easy, costeffective interventions for pathological worry. Further research is needed with clinical GAD samples, and research is also needed on the placebo response rate in GAD. / text

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

Made available in DSpace on 2016-03-22T17:27:38Z (GMT). No. of bitstreams: 1 dissert vanessa.pdf: 6002309 bytes, checksum: df2a2d8c85a5b63a3a7c2be3a3a28a5e (MD5) Previous issue date: 2006-06-02 / A ansiedade generalizada é um disorder mental comum e tem um prevalence de 5.1% para a vida (Kessler, 1994 e Meltzer, 1995). O comorbidity no meio GAD e o depression principal é comum e os povos com este comorbidity relatam que GAD têm o início antes do depression, predizendo o início subseqüente de sintomas depressive e de outros disorders (Kessler, 2000). Uma intervenção e um tratamento adiantados de preliminar GAD impediriam tal resultado.

<p>The aim of this study was to evaluate if a population suffering from generalized anxiety disorder could benefit from an Internet based self-help treatment guided via email contact with a therapist. The treatment was based on established cognitive behavioral principles. It was hypothesized that significant improvements would be found as measured by eight self report questionnaires, absence of a clinical diagnoses and global clinical improvement. A total of 89 participants were included and 44 were randomized to a treatment condition and 45 were assigned to a waitlist control. The controls received similar treatment after the first post treatment assessment, conducted eight weeks after the beginning or treatment of the first group. The results showed statistically significant improvements for the treatment group. No changes were observed in the waiting-list control group, with the exception of a minor decrease in depression scores. Large effect sizes were found both within the treatment group and between the two groups in favor of the treatment. In conclusion, Internet treatment can be an efficacious format for treating generalized anxiety disorder.</p>

The aim of this study was to evaluate if a population suffering from generalized anxiety disorder could benefit from an Internet based self-help treatment guided via email contact with a therapist. The treatment was based on established cognitive behavioral principles. It was hypothesized that significant improvements would be found as measured by eight self report questionnaires, absence of a clinical diagnoses and global clinical improvement. A total of 89 participants were included and 44 were randomized to a treatment condition and 45 were assigned to a waitlist control. The controls received similar treatment after the first post treatment assessment, conducted eight weeks after the beginning or treatment of the first group. The results showed statistically significant improvements for the treatment group. No changes were observed in the waiting-list control group, with the exception of a minor decrease in depression scores. Large effect sizes were found both within the treatment group and between the two groups in favor of the treatment. In conclusion, Internet treatment can be an efficacious format for treating generalized anxiety disorder.

Contemporary cognitive theories argue that socially anxious individuals adopt self-protective behavioural strategies under conditions of perceived social threat in order to prevent or diminish the likelihood of negative social outcomes. When performed in an anxiety-provoking but otherwise innocuous situation, however, safety behaviours are posited to facilitate biased processing of threat-relevant information, disrupt behavioural performance, elicit negative social responses, and ultimately prevent disconfirmation of fear-relevant beliefs. This dissertation project was designed to evaluate the effects of safety behaviour reduction strategies on a number of the core processes relevant to the persistence of pathological social fear. Two studies were conducted to address the following issues: Do safety behaviour reduction strategies influence socially anxious individuals’ (1) self- and social-judgments, (2) social performance, (3) the interpersonal reactions of oneself and others, and (4) appraisals of future social events. In study 1, in vivo safety behaviours were manipulated in a sample of 50 socially anxious students during a laboratory social interaction. Participants were randomly assigned to either a safety behaviour reduction (SB, n = 25) or exposure alone (control, n = 25) condition, and subsequently took part in two conversations with a trained experimental assistant. Results revealed that participants in the SB group displayed more accurate self-judgments of anxiety-related behaviour, improved social performance, and evoked more positive partner reactions. Study 2 was designed to replicate and extend the findings of study 1 in a sample of 80 patients seeking treatment for social anxiety disorder (SAD). Following a baseline conversation, participants were randomly assigned to the graduated exposure (GE, n = 40) or safety behaviour reduction condition (SB, n = 40). Consistent with the findings of study 1, the SB group displayed more accurate self-judgments about visible displays of anxiety, more effective social behaviour, and were better liked by their interaction partner relative to GE participants. Moreover, relative to controls, participants in the SB group made less negative judgments about the likelihood of previously identified feared outcomes pertaining to future social events. Implications of the present findings for elucidating the role of safety behaviours in the maintenance of SAD, and its treatment outcome will be considered.