Os transtornos de ansiedade (TAs) estão entre os principais problemas que acometem crianças e adolescentes, podendo atingir uma prevalência de até 24,9% ao longo da vida. A eficácia do tratamento de TAs na infância e na adolescência tem sido demonstrada em estudos de curto prazo de terapia cognitivo-comportamental (TCC), mas ainda são poucos os estudos que avaliam a eficácia da terapia de longo prazo. Portanto, a presente pesquisa tem por objetivo realizar uma revisão sistemática de estudos de seguimento sobre TCC com crianças e adolescentes com TAs (artigo 1) e verificar a resposta a longo prazo da terapia cognitivocomportamental em grupo (TCCG) em relação à intensidade dos sintomas de ansiedade e depressão e à qualidade de vida (artigo 2). Para a realização do primeiro artigo (revisão sistemática), foram consultadas as bases de dados Pubmed e Isi Web of Science. Foram considerados como critérios de inclusão: estudos de coorte após TCC para TAs na infância e na adolescência. Foram excluídos os estudos com período de seguimento inferior a um ano. Para a apresentação dos achados dos estudos, foram considerados os resultados significativos (p<0,05). Em relação ao método utilizado na elaboração do segundo artigo (seguimento não controlado), a pesquisa envolveu 20 adolescentes que realizaram 14 sessões de TCCG para TAs e foram reavaliados após 2 anos do término da intervenção. Para avaliar os desfechos, utilizaram-se os instrumentos antes da TCCG, no final (4 meses) e após 2 anos: Autorrelato para Transtornos Relacionados à Ansiedade na Infância (SCARED-C); Inventário de Depressão Infantil (CDI); Impressão Clínica Global (CGI); Escala de Funcionamento Global (CGAS) e Qualidade de Vida de Jovens (YQOL). O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegra (nº 110181). Os adolescentes e seus responsáveis assinaram o termo de consentimento livre e esclarecido (TCLE). Como resultado da revisão sistemática, obteve-se um total de 10 artigos que preencheram os critérios de inclusão. O período de seguimento variou entre 12 meses a 13 anos e, em geral, os resultados indicaram a manutenção dos ganhos com a TCC de curto prazo. No entanto, os estudos apresentaram limitações, principalmente em relação ao método, como ausência de grupo controle e perdas de seguimento. No estudo de seguimento, um total de 19 (95%) adolescentes com média de idade de 12,3 (DP=1,0) anos foi avaliado. Houve redução significativa (p<0,001) da gravidade dos sintomas (CGI) e melhora do funcionamento global (CGAS) em comparação com a avaliação inicial. A qualidade de vida geral no seguimento melhorou significativamente (p=0,041) em comparação com a avaliação inicial e final da 7 TCCG. Os sintomas específicos de ansiedade e depressão não apresentaram mudanças significativas (p=0,071 e p=0,206, respectivamente). Os resultados do trabalho sugerem a manutenção dos benefícios da TCC de longo prazo e encorajam a sua utilização entre adolescentes com TAs. / Anxiety disorders (ADs) are among the most prevalent conditions affecting children and adolescents with a lifetime prevalence of up to 24.9%. The efficacy of treatment for ADs in childhood and adolescence has been demonstrated in short-term studies of cognitivebehavioral therapy (CBT), but few studies have investigated the long-term effects of this treatment. Therefore, the present study aimed to systematically review follow-up studies of CBT in children and adolescents with ADs (article 1) and explore the long-term effects of group cognitive-behavioral therapy (GCBT) on quality of life and symptoms of anxiety and depression (article 2). The systematic review was based on a search of the PubMed and ISI Web of Science databases. Articles reporting cohort studies of CBT for ADs in childhood and adolescence were included in the review. Studies with follow-up periods of less than one year were excluded. Results were considered significant at p < 0.05. The second article consisted of an uncontrolled follow-up study involving 20 adolescents who underwent 14 sessions of GCBT for ADs and were assessed at three time points (before and after treatment, and two years after the end of treatment) with the following instruments: Screen for Child Anxiety Related Emotional Disorders, child (SCARED-C); Children's Depression Inventory (CDI); Clinical Global Impression (CGI); Children’s Global Assessment Scale (CGAS) and Youth Quality of Life (YQOL). The study was approved by the Hospital de Clínicas de Porto Alegre Research Ethics Committee (protocol number 110181). Participants and guardians provided written informed consent prior to participation. Ten articles were included in the systematic review. Follow-up periods ranged from 12 months to 13 years, with most studies indicating that the effects of short-term CBT remained stable over time. However, the studies presented a series of methodological limitations, such as lack of control groups and follow-up losses. In the present follow-up study, a total of 19 (95%) adolescents with mean age 12.3 (SD=1.0) years were assessed. There were significant reductions (p<0.001) in symptom severity (CGI) and improvements in global functioning (CGAS) over the course of the study. General quality of life improved significantly at follow-up (p=0.041) as compared to assessments immediately before and after GCBT. There were no significant differences in anxiety and depression symptoms (p=0.071 and p=0.206, respectively). Results of the present studies indicate that the benefits of CBT are maintained over time, and that this method is suitable for the treatment of ADs in adolescents.

INTRODUÇÃO. A comorbidade entre cefaléias e transtornos psiquiátricos vem sendo enfatizada como um dos aspectos mais importantes no manejo dos pacientes com cefaléias primárias. Os transtornos de ansiedade, além dos de humor, são um dos diagnósticos de maior importância neste contexto. O transtorno de ansiedade generalizada (TAG) é o transtorno de ansiedade mais associado à enxaqueca. Apesar da relevância do tema, é surpreendente a escassez de estudos sobre o impacto das cefaléias primárias em pacientes com TAG. OBJETIVO. O objetivo deste estudo foi de avaliar a prevalência ao longo da vida e o impacto das cefaléias primárias em pacientes com e sem TAG. MÉTODOS. Sessenta pacientes foram incluídos no estudo: 30 pacientes com diagnóstico de TAG, de acordo com a entrevista estruturada SCID-1/P, e 30 controles saudáveis. Todos os pacientes passaram por entrevista clínica enfocando variáveis demográficas (idade, sexo, escolaridade e estado civil), antropométricas (peso, altura e IMC), relativas às cefaléias (intensidade, duração, freqüência, aura, tempo de história e consumo de analgésicos), gravidade da sintomatologia (ansiosa, depressiva, de fadiga e de sonolência diurna) e conseqüências médico-sociais (incapacidade funcional, utilização de serviços de saúde e qualidade de vida). As cefaléias primárias foram avaliadas através de entrevista estruturada e foram empregados os critérios da Classificação Internacional das Cefaléias (2a edição) para realização de seu diagnóstico. RESULTADOS. 86,6% dos pacientes com TAG receberam algum diagnóstico de cefaléia, sendo a enxaqueca o diagnóstico mais comum. Comparados aos controles, os pacientes com TAG apresentaram odds ratio maior para cefaléias primárias (RC=7,43) e também para enxaqueca (RC=13,00), enxaqueca episódica (RC=6,88) e aura (RC=10,55). Já nos controles, apenas 47% receberam algum diagnóstico de cefaléia, sendo CTT episódica infreqüente o diagnóstico mais comum. DISCUSSÃO/CONCLUSÃO. O diagnóstico de cefaléias primárias é mais comum em pacientes com TAG do que nos controles. A enxaqueca é o diagnóstico mais comum em pacientes com TAG e também mais freqüente em TAG que em controles. A cefaléia do tipo tensional (CTT) freqüente é igualmente comum em ambos os grupos. É importante realizar o diagnóstico de cefaléias primárias em pacientes com transtornos de ansiedade, em especial o TAG, pois a sua correta avaliação deve implicar em um manejo mais preciso dos pacientes com TAG e resultar em desfechos clínicos mais favoráveis. / OBJECTIVES. Anxiety disorders and headaches are comorbid conditions, but no research has been done on the prevalence and impact of primary headaches in generalized anxiety disorder (GAD) patients. The study\'s aim was to analyze lifetime prevalence and impact of primary headaches in patients with and without generalized anxiety disorder. METHODS. Sixty participants were enrolled in the study; 30 GAD patients diagnosed according to the DSM-IV were compared to 30 healthy control subjects. All patients were interviewed for psychiatric assessment using the SCID-I/P. Primary headaches were diagnosed using ICHD-II criteria for structured interview. RESULTS. Migraine was the most common diagnosis in generalized anxiety disorder patients. The prevalence of migraine was highest among GAD patients as opposed to controls (66.7% vs 13.3%; p<0.001; OR=13.00; 95% CI=3.55-47.6), episodic migraine (43.3% vs 10%; p=0.004; OR=6.88; 95% CI=1.71-27.75), chronic daily headache (20% vs 0; p=0.024) and aura (26.6% vs 3.3%; p=0.026; OR=10.55; 95% CI=1.23-90.67). Tension Type Headache (TTH) was equal for controls and the GAD group (20% vs 33.3%; p=0.243).The characteristics of migraines (frequency, intensity, duration, and consumption of analgesics), symptoms such as anxiety, depression, fatigue, and daytime sleepiness, as well as the medical-social consequences (functional incapacity, use of health services and quality of life) were worse in GAD patients than in controls. CONCLUSION. Primary headaches in general, and migraine in particular, are significantly more common in GAD patients than controls. GAD aggravates headaches. Primary headache diagnosis is important for anxiety disorder patients, particularly those with GAD, since correct assessment may lead to better patient management and clinical outcomes.

The main objective of this study has been to explore how art therapists experience the visual art´s that can be used in the promotion of health among people with depression - and anxiety disorders. The concept of SOC- sense of coherence has been a central term and a link between imaging and SOC were identified in the study. The underlying method in the study was a qualitative form, where semi-structured interviews were used. Through a strategic- sample five female art therapist were contacted, who all came to participate in the study. The study is essentially based on hermeneutical method and the analysis of interview material has been analyst by using thematic analysis. The results indicate that the therapists experiences shows that  visual art can be a support for people with depression- and anxiety disorders. The SOC- concept made its mark in the result and it came to show that the visual art´s may be a support for people with depression- and anxiety disorders. Visual art can help people with depression- and anxiety disorders to get more understanding and tools to manage their state according to the therapists.

Os transtornos de ansiedade estão entre os transtornos psiquiátricos mais prevalentes na infância e adolescência, sendo associados a prejuízos no desempenho social, familiar e acadêmico. Sua origem é multifatorial, com contribuições genéticas e ambientais, dentre elas o aprendizado e a associação com a psicopatologia e o estilo parental. Estudos têm sugerido a relação da psicopatologia entre pais e filhos e sua influência na resposta ao tratamento. Os dois estudos desta dissertação se inserem neste contexto e buscam investigar os benefícios da inserção dos pais no tratamento dos filhos (Artigo1), a influência da psicopatologia parental na sintomatologia e resposta ao tratamento da prole e o quanto o tratamento dos filhos pode acarretar na melhora da sintomatologia dos pais (Artigo2). O primeiro artigo teve como finalidade estudar a influência da inserção dos pais no tratamento dos filhos por meio de uma revisão sistemática, a fim de compreender seus possíveis benefícios na resposta ao tratamento. A maior parte dos estudos revisados neste artigo não demonstrou resultados mais satisfatórios com a inclusão dos pais no tratamento das crianças em intervenções psicossociais. Entretanto, aqueles que encontraram melhores resultados com inclusão dos pais possuíam em comum a presença e participação ativa dos mesmos. Além disso, resultados apresentados no follow-up indicaram melhora entre as crianças que realizaram intervenção junto aos pais, sugerindo que a inserção parental pode acarretar em benefícios ao longo do tempo. Este estudo avança na compreensão da inclusão dos pais no tratamento dos filhos por demonstrar que aspectos como o tempo dedicado ao tratamento, relação custo-benefício e o papel dos pais na prevenção a recaída dos sintomas merecem a atenção de futuras pesquisas. O segundo artigo teve a intenção de avaliar a psicopatologia e o repertório de habilidades sociais das mães antes e após o tratamento com Terapia Cognitivo Comportamental (TCC) em grupo focado nas crianças com ansiedade. Este estudo foi realizado por meio de um ensaio clínico randomizado e teve como objetivo investigar a influência das variáveis maternas no tratamento dos filhos e, se a intervenção focada na criança pode acarretar na melhora da sintomatologia materna. Este estudo mostrou que a psicopatologia e o repertório de habilidades sociais das mães não foram preditores da resposta ao tratamento dos filhos. Embora tenha ocorrido redução na ansiedade e depressão materna após a intervenção, esta diferença não foi considerada significativa, sugerindo que o tratamento focado nos filhos não influencia positivamente a sintomatologia dos pais. Este estudo avança no entendimento da influência dos pais sobre os filhos por demonstrar que a resposta ao tratamento não foi influenciada pelas variáveis parentais. Este estudo contribui também para a compreensão dos efeitos do tratamento dos filhos sobre os pais demonstrando que, embora os pais não tenham sido influenciados pela intervenção focada na criança, este é um interessante campo de pesquisa, podendo ser o foco de novos estudos. / Anxiety disorders are among the most prevalent psychiatric disorders in childhood and adolescence, and they are associated with impairments in social, family and academic performance. Their origin is influenced by genetic and environmental factors, such as learning and there is an association with parental psychopathology and parenting style. Studies have suggested that there is a relationship between parental anxious symptoms and their children symptoms that could influence treatment response. This study comprises two manuscripts that aim to investigate the benefits of the parental inclusion in their anxious children’s treatment (Paper1), as well as the influence of parental symptoms in their anxious offspring treatment, and if the anxiety treatment in the children can result in their parental symptoms improvement (Paper2). The first paper aimed to study, throughout a systematic review of the literature, the influence of parental inclusion in the outcome of their anxious children psychosocial intervention. Most of the revised studies suggested that the inclusion of parents in their children’s intervention did not contribute to a better treatment response. However, between those studies that reported a significant positive influence of parental inclusion they all showed an active participation of these parents. Furthermore, the follow up data reported a significant improvement among children who underwent intervention with their parents, suggesting that parental inclusion might result in benefits over time. This study expands the understanding of parental inclusion in their children’s treatment by demonstrating that aspects, such as the time devoted to treatment, cost-effectiveness and the role of parents in preventing symptoms relapse, deserve attention in future research. The second paper was intended to assess parental symptoms and social skills before and after Cognitive Behavioral Therapy (CBT) group with their children with anxiety disorder. This study aimed to investigate the influence of parental characteristics in the outcome of their children group CBT treatment and also if the child-focused intervention could result in improvement of parental symptoms. This study demonstrated that parental symptoms and social skills were not predictors of response to the children’s treatment. Although there was a decreased in maternal anxiety and depression symptoms after the intervention, this difference was not statistically significant, suggesting that children treatment do not have influence in their mothers´ symptoms. This study contributes to the understanding of the parental influence on their anxiety disordered children symptoms and treatment outcomes. Furthermore, this study added to the literature concerning the absence of the effects of children’s treatment and improvement on parental symptoms. This is an interesting field with controversial data that should be focus of new studies.

OBJECTIVE: Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7. METHODS: Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM). RESULTS: The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7. CONCLUSION: The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis. / : This research was supported by an award from the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835) at the National Institutes of Health (NIH). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication / Revisión por pares

Der Langzeitverlauf und die Häufigkeit sogenannter spontaner Remissionen wurde anhand von 77 Fallen mit einer Lifetime-Diagnose einer Angststörung untersucht. Die 77 Angstfälle wurden als Teil der Münchner Follow-up-Studie im Rahmen einer allgemeinen Bevölkerungsuntersuchung im Jahre 1974 identifiziert und wurden über einen Zeitraum von sieben Jahren (bis 1981) weiter untersucht. Die Diagnosen wurden einerseits durch ein standardisiertes diagnostisches Instrument (den DIS), andererseits über eine klinisch-psychiatrische Nachuntersuchung (1981) abgesichert. In Ergänzung hierzu wurde der Verlauf der psychopathologischen Symptome sowie die psychologische und psychosoziale Integration der Versuchspersonen beurteilt. Ergebnisse: Die Lebenszeit-Prävalenz, irgendeine Anststörung zu entwickeln, betrug 13,9%. Einfache und soziale Phobien wiesen eine Prävalenz von 8,0%, Agoraphobie von 5,7%, Zwangsstörungen von 2,0% und Panikstörungen von 2,4% auf. Die Inzidenz, d.h. das Auftreten neuer Fälle im Zeitraum zwischen der Erst- und Zweituntersuchung war niedrig, mit Ausnahme für Panikstörungen (1,2%, bei einer Gesamtprävalenz von 2,4%) und Agoraphobie (1,3% bei einer Gesamtprävalenz von 5,7%). Die Komorbidität war sowohl innerhalb der Angststörungen wie auch bezüglich anderer psychischer Störungen erhöht. 62% hatten mehr als eine Angstdiagnose, Major Depression und Abhängigkeit von Alkohol oder Medikamenten waren die häufigsten komorbiden Störungen, die in der überwiegenden Mehrzahl deutlich nach dem Beginn der Angststörung auftraten. Spontanremissionen wurden auf drei unterschiedlichen Ebenen definiert, von denen ein Kombinationsmaβ als Hauptergebnis interpretiert wurde. Danach war die symptomatische Remission in alien Angstgruppen niedrig, während die psychosoziale Remissionsrate ein günstigeres Bild mit Remissionsraten zwischen 28,6% für Panikstörung und 53,1% für einfache und soziale Phobien ergab. Das kombinierte spontane Remissionsmaβ ergab für keine der Zwangsstörungen, nur 14,3% der Panikstörungen, 19,2% der Agoraphobien und 18,8% der einfachen und sozialen Phobie eine voile Remission. Die Ergebnisse unterstreichen, daβ Angststörungen zumeist in der Kindheit oder frühen Adoleszenz beginnen und dazu neigen, chronisch über den Groβteil des Lebens zu persistieren und nur selten zu remittieren.

Hintergrund: Angststörungen gehören zu den häufigsten psychischen Störungen im Jugend- und Erwachsenenalter. Ein Großteil der Betroffenen bleibt meist unbehandelt. Informationen über die Behandlungswahrscheinlichkeit bei Jugendlichen und jungen Erwachsenen in Abhängigkeit von der Störungs- und Behandlungsart, Lebensalter, Geschlecht und Komorbidität liegen bisher nicht vor. Methode: In einer repräsentativen Stichprobe 14- bis 34-Jähriger aus dem Großraum München (Early Developmental Stages of Psychopathology Studie, N = 3021) werden die Prävalenz und Lebenszeitinzidenz von Angststörungen sowie ihre Behandlungsraten mittels M-CIDI erfasst und differenziert für Lebensalter, Komorbidität und Geschlecht präsentiert. Ergebnisse: 30% der Befragten berichteten mindestens eine Angststörung in ihrem Leben. Fast die Hälfte der Betroffenen (43%) suchte irgendeine Behandlung, ein Drittel (28%) suchte einen Psychotherapeuten auf. Für die meisten Angststörungen lagen hohe Quoten psychotherapeutischer Behandlungen vor (Range: 50–61%). Jugendliche berichteten seltener als Erwachsene irgendeine Behandlung, eine psychotherapeutische Behandlung, die Konsultation eines Psychiaters oder Hausarztes. Frauen nahmen häufiger eine Psychotherapie in Anspruch als Männer. Das Vorliegen einer komorbiden Angst- oder depressiven Störung erhöhte die Behandlungswahrscheinlichkeit. Diskussion: Verglichen mit europäischen Studien berichtete die Stichprobe relativ häufig eine Behandlung, auch eine psychotherapeutische. Dies kann eine Folge des großen Behandlungsangebotes in München sein. Dennoch bleibt der Großteil der jungen Betroffenen unbehandelt. Zur Prävention langfristiger Beeinträchtigungen sowie sekundärer psychischer Störungen sollte das Versorgungssystem verstärkt auf diese Bevölkerungsgruppe ausgerichtet werden. / Background: Anxiety disorders are among the most frequent mental disorders in adolescence and adulthood. Most of the affected individuals do not receive treatment. Information about treatment use among adolescents and young adults, differentiated for the kind of treatment and anxiety disorder, age, gender and co-morbidity, is still missing. Methods: In a representative sample of 14–34 year-old adolescents and young adults of the Munich area (Early Developmental Stages of Psychopathology study, N = 3,021) prevalence and lifetime incidence of anxiety disorders and treatment use are assessed using the M-CIDI and will be presented for age, co-morbidity and gender. Results: 30% of all participants reported at least one lifetime diagnosis of an anxiety disorder. Almost half of those affected (43%) received some kind of treatment; one third (28%) received psychotherapy. Psychotherapy use was frequent in most anxiety disorders (range: 50–61%). Older individuals more frequently reported any treatment, psychotherapy, consultations with psychiatrists or general practitioners. Women used psychotherapy more often than men. Co-morbid anxiety or depressive disorders increased the probability of treatment use. Discussion: As compared to European estimations, we found relatively high rates of treatment use. This may be due to the many treatment possibilities in the Munich area. Nevertheless, most young people affected do not receive treatment. Considering the long-term effects of anxiety disorders and in order to prevent secondary disorders, efforts should be increased to reach these young individuals.

Background: Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking. Aims: To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes. Study design: DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes. Results: Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring. Conclusion: Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Bakgrund: Psykisk ohälsa förekommer i alla åldrar och är ett växande problem. Animal Assisted Therapy (AAT) är en målinriktad, planlagd och strukturerad terapeutisk insats som leds eller utförs av personal inom hälso- och sjukvård, skola eller omsorg. Inom hälso- och sjukvården syftar AAT till att förbättra individens psykiska, fysiska, emotionella och kognitiva förmågor. Syfte: Att kartlägga effekter avseende ångest hos vuxna personer med psykisk ohälsa som genomgår Animal Assisted Therapy. Metod: Litteraturstudien baseras på åtta empiriska interventionsstudier med kvantitativ design. Databassökningar genomfördes i Cinahl, PubMed och PsycInfo. Analysprocessen genomfördes enligt Popenoes analysmodell. Resultat: Samtliga studier resulterade i en minskning avseende ångest. Sex av studierna visade en signifikant minskning inom gruppen som fått AAT och två studier visade en positiv effekt men utan signifikant skillnad. Två studier visade en signifikant skillnad mellan interventions- och kontrollgruppen.  Konklusion: Litteraturstudiens resultat visade att AAT kan reducera ångest hos individer med psykisk ohälsa och kan därför vara ett bra komplement i omvårdnaden hos denna patientgrupp. Ytterligare forskning behövs för att kartlägga hur effektivt AAT är jämfört med befintliga behandlingar. / Background: Mental illness occurs at all ages and is a growing problem. Animal Assisted Therapy (AAT) is a targeted, planned and structured therapeutic intervention led or performed by staff in health care, school or care. Animal Assisted Therapy aims in healthcare to improve the individual's mental, physical, emotional and cognitive abilities. Aim: To map the effects regarding anxiety in adults with mental illness who undergo Animal Assisted Therapy.  Methods: The literature review is based on eight empirical intervention studies with quantitative design. Database search was conducted in Cinahl, PubMed and PsycInfo. The analysis process was carried out according to Popenoe´s analysis model. Results: All studies resulted in decreased anxiety-levels. Six of the studies showed a significant difference within the group that received AAT and two studies showed a positive effect but without a significant difference. Two studies showed a significant difference between the intervention and control groups. Conclusion: The results of the literature study showed that AAT can reduce anxiety in individuals with mental illness and could therefore be a good complement to the care of this patient group. Further research is needed to map how effective AAT is compared to existing treatments.