Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.

No description available.

No description available.

Following a review of treatment outcome study methodology, a comparative study of psychological versus pharmacological treatments was conducted; subsidiary studies investigated aspects of treatment outcome in more detail. 193 patients with DSM III-R panic disorder with or without agoraphobia were randomly allocated to; fluvoxamine, placebo, fluvoxamine + CBT (cognitive behaviour therapy), placebo + CBT, or CBT alone. Patients received no concurrent treatments and were treated to the same schedule, with therapist contact balanced across groups. Treatments were conducted in the primary care setting. Outcome at treatment end-point and 6 month follow-up, assessed in terms of both statistical and clinical significance, showed patients receiving active treatments improved significantly, with improvement better preserved over follow-up in the groups receiving CBT. The CBT alone and fluvoxamine + CBT groups showed the most consistent gains, the latter group showing gains earliest in treatment. Outcome was also investigated using brief global ratings of symptom severity, change in symptoms following treatment, general wellbeing and social disruption, completed by psychologist, referring GPs, and patients. Using these measures all active treatments showed statistical advantage over placebo with the groups employing CBT showing the most robust and consistent response. Overall there were no significant differences in drop-out rates between groups although the drop-out rate for patients receiving CBT alone was higher than that for placebo + CBT. Agreement with main outcome measures was demonstrated for psychologist and patient ratings, but not for GP ratings. An investigation of panic attack variables as treatment outcome measures indicated that these did not function as discriminative treatment outcome measures with all treatment groups showing significant reductions in panic attack variables over treatment with few significant differences between treatment groups on any variable throughout treatment. An investigation of prognostic indicators of treatment outcome indicated good prediction of post treatment response using pre-treatment measures of anxiety level, frequency of panic attacks, extroversion and treatment group. Predictions of outcome at 6 month follow-up were less robust. Results are discussed in terms of their relevance to wider clinical practice.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2004. / Härtill 5 uppsatser.

The current investigation examined the singular and interactive effects of anxiety sensitivity (AS) and perceived control over anxiety-related events in the prediction of panic symptoms using a biological challenge paradigm. Two hundred and twenty-nine participants (mage = 21.02, SD = 7.55, 124 females) were recruited from the greater Burlington, Vermont community. Results indicated that pre-challenge AS, but not perceived control over anxiety-related events, significantly predicted post-challenge panic attack symptoms, anxiety focused on bodily sensations, and interest in returning for another challenge (behavioral avoidance). There were no interactive effects between AS and perceived control over anxiety-related events. For the physiological measures, pre-challenge AS was predictive of change in skin conductance level (pre-post challenge), and pre-challenge perceived control over anxiety-related events was predictive of change in respiration rate (breathes per minute). No significant effects were evident for heart rate and there were no significant interactive effects between AS and perceived control over anxiety-related events for any of the physiological variables. Findings of the investigation are discussed in relation to the role of AS and perceived control over anxiety-related events in terms of vulnerability for panic psychopathology.

<p>Ett nytt sätt att behandla panikångest i form av gruppterapi med KBT redovisas ur ett patientperspektiv. Gruppterapeutisk historia och beståndsdelar i KBT tas upp liksom skamkänslor, ”compliance” och ”holding”. Fem kvinnor och tre män ur olika terapigrupper och med olika bakgrund intervjuades om sina upplevelser. Deltagarnas förväntningar, erfarenheter av gruppsammansättning och gruppdynamik samt gruppens bidrag till personliga förändringar och insikter studerades. Materialet bearbetades genom begreppskategorisering. Farhågor och förväntningar på andra deltagare dominerade hos deltagarna inför terapin. Under terapins gång hade andra deltagare motiverat och uppvärderat varandras behandlingsarbete samt visat på att individen inte var ensam om sitt tillstånd. Ingen var helt fri från panikångest efter behandling men har kunnat återerövra delar av sitt liv. Alla planerade någon form av behandlingsfortsättning.</p>

Ett nytt sätt att behandla panikångest i form av gruppterapi med KBT redovisas ur ett patientperspektiv. Gruppterapeutisk historia och beståndsdelar i KBT tas upp liksom skamkänslor, ”compliance” och ”holding”. Fem kvinnor och tre män ur olika terapigrupper och med olika bakgrund intervjuades om sina upplevelser. Deltagarnas förväntningar, erfarenheter av gruppsammansättning och gruppdynamik samt gruppens bidrag till personliga förändringar och insikter studerades. Materialet bearbetades genom begreppskategorisering. Farhågor och förväntningar på andra deltagare dominerade hos deltagarna inför terapin. Under terapins gång hade andra deltagare motiverat och uppvärderat varandras behandlingsarbete samt visat på att individen inte var ensam om sitt tillstånd. Ingen var helt fri från panikångest efter behandling men har kunnat återerövra delar av sitt liv. Alla planerade någon form av behandlingsfortsättning.

My thesis explores how discourse and material practices have created agoraphobia, the fear of public places. This psychological disorder predominates among women. Throughout much of Western history, women have been encouraged to stay home for their safety and for the safety of society. I argue that agoraphobic women have internalized this discourse, expressing fears of being in public or being alone without a companion to support and protect them; losing control over their minds or their bodies; and endangering or humiliating themselves. Therapeutic discourse also has created agoraphobia by naming it, categorizing the emotions and behaviors associated with it, and describing the characteristics of agoraphobics. The material practice of therapy reinforces this discourse. Meanwhile, practices such as rape and harassment reinforce the dominant discourse on women’s safety. I survey psychological literature, beginning with the naming of agoraphobia in 1871, to explain why the disorder is now diagnosed primarily in women. I examine nineteenth-century discourse that told women they belonged at home while men controlled the public domain. In 1871, the Paris Commune revolt epitomized the fear of women publicly out of control. I return to Paris a century later for a reading of the novel Certificate of Absence, in which Sylvia Molloy explores identity through the eyes of a woman who might be labeled agoraphobic. I ask whether homebound women are resisting or retreating from a hostile world. Instead of seeing agoraphobia only as a personal problem, people should question why so many women fear themselves and the world outside their home. My methodology includes an analysis of nineteenth-century texts as well as current media, prose, and poetry. I also support my arguments with material from professional journals and nonfiction books in different disciplines. Common to feminist research, an interdisciplinary approach was needed to situate a psychological disorder within a social context.

Doctor of Philosophy (PhD) / The purpose of this thesis was to investigate relationships between treatment knowledge, beliefs and outcome in Panic Disorder and/or Agoraphobia (Panic-Ag). Research from the psychotherapy and medical literature indicates patients’ treatment knowledge and beliefs, specifically acceptance of the treatment rationale (ATR), expectancies of treatment outcome (ETO) and treatment self-efficacy (TSE), are associated with clinical outcomes for a range of disorders. However, methodological limitations surrounding measurement of these constructs have undermined conclusions and/or such relationships have not been investigated in the field of Panic-Ag. Relationships between treatment knowledge, beliefs and outcome in Panic-Ag were examined using a 2 phase procedure. Phase 1 involved developing measures of treatment knowledge, ATR, ETO and TSE using patient and clinician samples. The psychometric properties of these measures were found to be satisfactory. Phase 2 investigated associations between treatment knowledge, beliefs and outcome following cognitive behaviour therapy (CBT) among 41 Panic-Ag participants. Measures were administered at pretreatment and 6-months posttreatment. It was hypothesised that treatment knowledge, ATR, ETO and TSE would be related to outcome, with associations mediated by belief in catastrophic cognitions. Of 4 Panic- Ag outcome measures (panic attack frequency, panic sensation severity, frequency of catastrophic cognitions and agoraphobic avoidance), results indicated improved treatment knowledge was significantly associated with frequency of catastrophic cognitions and agoraphobic avoidance. Posttreatment TSE was significantly associated with panic attack sensation severity, frequency of catastrophic cognitions and agoraphobic avoidance. Contrary to the hypothesis, ATR was not related to outcome. Similar findings concerning TSE and ATR were obtained in an independent sample of 34 Panic-Ag participants. Exploratory analyses found that pretreatment beliefs including outcome expectancies were unrelated to outcome. Mediational analyses revealed relationships between TSE and outcome were partially mediated by belief in catastrophic cognitions while relationships between treatment knowledge and outcome were not. Results are discussed in light of previous research, methodological limitations, clinical implications and future research directions.